Abstract

Infections are responsible for most treatment-related morbidity and mortality in pediatric acute myeloid leukemia (AML). Children’s Oncology Group (COG) recommends hospitalization following chemotherapy until early absolute neutrophil count (ANC) recovery. No standard guidelines exist for antibiotic prophylaxis and discharge practices vary. Our objective was to report our institution’s experience with outpatient supportive care management following early discharge. A retrospective chart review of pediatric AML patients treated at our institution from 2010 to 2019 was conducted. Data was collected on length of hospitalization, antibiotics administered, infections, and neutropenia duration. Seventeen patients underwent 60 chemotherapy cycles. All were discharged after completion of chemotherapy if clinically stable. Patients were re-admitted for fever and discharged on empiric antibiotics if afebrile with negative cultures. Prophylactic antibiotics were administered in 55 cycles. There were 12 infections in 11 patients and no deaths due to infection. Patients remained outpatient for a mean of 15.8 neutropenia days per cycle. Outpatient supportive care for children with AML may be feasible and safe. Further studies are needed to establish outpatient supportive care guidelines.

摘要

感染是小儿急性髓性白血病 (AML) 中大多数与治疗相关的发病率和死亡率的原因。儿童肿瘤学组 (COG) 建议在化疗后住院直至早期绝对中性粒细胞计数 (ANC) 恢复。没有针对抗生素预防的标准指南，并且出院实践各不相同。我们的目标是报告我们机构在早期出院后进行门诊支持性护理管理的经验。对 2010 年至 2019 年在我们机构治疗的儿科 AML 患者进行了回顾性图表审查。收集了有关住院时间、抗生素使用、感染和中性粒细胞减少持续时间的数据。17 名患者接受了 60 个化疗周期。如果临床稳定，则在完成化疗后全部出院。患者因发热再次入院，如果培养阴性但无发热，则使用经验性抗生素出院。在 55 个周期内给予预防性抗生素。11例患者感染12例，无感染死亡病例。患者每个周期的平均中性粒细胞减少天数为 15.8 天。对患有 AML 的儿童的门诊支持治疗可能是可行和安全的。需要进一步的研究来建立门诊支持性护理指南。