Outpatient Management of Acute Leukemia: A Systematic Review and Meta Analysis

Abstract

Background/Aim: Outpatient chemotherapy administration for solid tumors is a commonly accepted practice given its advantage of easy and safe drug administration, ability to value the patient’s wish to avoid hospitalization and decreased expenses compared to inpatient care. However, this practice is not commonly extended to patients with acute leukemia. The aim of this study was to compile the evidence about outpatient and early discharge of acute leukemia patients and its effects on the outcome. Methods: A systematic review was done using MEDLINE, EMBASE and Cochrane Library databases. Both retrospective and prospective cohort studies as well as clinical trials for acute leukemia were included. Results: Twenty one studies were included in this systematic review: Ten retrospective studies, 10 prospective studies and one non-randomized phase 2 trial. Most of the included studies reported that outpatient chemotherapy is feasible, safe, and resulted in decreased hospitalization days. Conclusion: Studies reporting on outpatient and early discharge of acute leukemia are largely observational and highly heterogeneous. A trend towards a reduced incidence of septicemia was observed with early discharge. The effect of other clinical outcome measures was unclear. Reporting on social and economic impact is suboptimal.