HOME CARE ADMINISTRATION OF SUBCUTANEOUS AZACITIDINE (AZA) AND DOMICILIARY MANAGEMENT OF FRAIL PATIENTS AFFECTED BY ACUTE MYELOID LEUKEMIA/MYELODYSPLASTIC SYNDROME: A FEASIBILITY STUDY
(Abstract release date: 05/19/16)
EHA Library. Cartoni C. 06/09/16; 134560; PB1660
Dr. Claudio Cartoni
Contributions
Contributions
Abstract
Abstract: PB1660
Type: Publication Only
Background
Home delivery of parenteral antineoplastic agents may allow an appropriate treatment for frail or disable patients (pts) with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS), whose management would be otherwise hampered by clinical barriers or conditioned by hospitalization requirements.
Aims
To describe the feasibility of a home care (HC) program that provides a managing package capable of supporting pts with their parenteral AZA therapy at home.
Methods
A retrospective analysis of the clinical features, use of resources, follow-up and HC satisfaction rating of frail homebound pts affected by AML or intermediate-high risk MDS with a clinical frailty scale score >4, who received at home subcutaneous AZA (75 mg/sqm/7 days).
Results
Overall, 106 pts with AML/MDS received AZA therapy; in 13 out of 31 pts (4%) with AML and in 7 out of 75 pts (9%) with MDS, the drug was administered at home. Reasons for the HC solution were: i) disability in 15 pts (11 AML/4 MDS), ii) early discharge from the ward in 5 (2 AML/3 MDS). The pts’ median age was 76 yrs (range 59-83), Karnofsky PS 50% (range 40-60%), Activity Dayly Living score 4 (range 1-6), Charlson co-morbidity index 2 (range 1-3). The mean No. of AZA courses in AML and MDS patients was 3 (1-6) and 2 (1-4), respectively. At home, 409 units of packed red cells were transfused, with a mean No. of 20 units transfused/per patient (range 0-94). During AZA therapy, 13 pts had infections with a mean No. of infections/patient of 1.9 (range 0-7). In 37 out of 38 cases (97%), infections were managed at home with i.v. antibiotic administration. Overall, hospitalization occurred in 8 out of 20 pts (40%). AZA therapy at home was started as a first course in 6 pts, whereas it was continued in 14 pts following courses already delivered at hospital, with a mean No. of 2.8 courses (range 1-4) and 2.1 (range 1-6), administered respectively. In 83% of cases, pts rated HC as more than good. Eighteen pts discontinued HC AZA: 15 due to disease progression and 3 because of an infection-related hospitalization. The median length of HC after AZA interruption was 111 days (1-343). Two pts are still on treatment with AZA, 18 pts have died: 11 at home or at a hospice, 7 while hospitalized. The pts median survival time from the start of AZA was 143.2 days (range 5-284) for AML pts and 229.7 days (range 49-411) for MDS pts.
Conclusion
Home administration of AZA proved feasible through the availability of a domiciliary service that guaranteed a high number of transfusions, blood sampling and i.v. antimicrobial therapy, combined with an approach of palliative care. Pts with poor prognosis AML/MDS had the opportunity of undergoing a specific epigenetic treatment at home, while living a considerable time interval outside the hospital with a high satisfaction level for HC. Inappropriate hospitalizations were reduced, with an overall median time at home of nearly 5 months for AML and 7.6 months for MDS pts. Death during the hospice care occurred in 61% of cases.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Histone deacetylase inhibitor, MDS/AML, Myeloid malignancies
Type: Publication Only
Background
Home delivery of parenteral antineoplastic agents may allow an appropriate treatment for frail or disable patients (pts) with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS), whose management would be otherwise hampered by clinical barriers or conditioned by hospitalization requirements.
Aims
To describe the feasibility of a home care (HC) program that provides a managing package capable of supporting pts with their parenteral AZA therapy at home.
Methods
A retrospective analysis of the clinical features, use of resources, follow-up and HC satisfaction rating of frail homebound pts affected by AML or intermediate-high risk MDS with a clinical frailty scale score >4, who received at home subcutaneous AZA (75 mg/sqm/7 days).
Results
Overall, 106 pts with AML/MDS received AZA therapy; in 13 out of 31 pts (4%) with AML and in 7 out of 75 pts (9%) with MDS, the drug was administered at home. Reasons for the HC solution were: i) disability in 15 pts (11 AML/4 MDS), ii) early discharge from the ward in 5 (2 AML/3 MDS). The pts’ median age was 76 yrs (range 59-83), Karnofsky PS 50% (range 40-60%), Activity Dayly Living score 4 (range 1-6), Charlson co-morbidity index 2 (range 1-3). The mean No. of AZA courses in AML and MDS patients was 3 (1-6) and 2 (1-4), respectively. At home, 409 units of packed red cells were transfused, with a mean No. of 20 units transfused/per patient (range 0-94). During AZA therapy, 13 pts had infections with a mean No. of infections/patient of 1.9 (range 0-7). In 37 out of 38 cases (97%), infections were managed at home with i.v. antibiotic administration. Overall, hospitalization occurred in 8 out of 20 pts (40%). AZA therapy at home was started as a first course in 6 pts, whereas it was continued in 14 pts following courses already delivered at hospital, with a mean No. of 2.8 courses (range 1-4) and 2.1 (range 1-6), administered respectively. In 83% of cases, pts rated HC as more than good. Eighteen pts discontinued HC AZA: 15 due to disease progression and 3 because of an infection-related hospitalization. The median length of HC after AZA interruption was 111 days (1-343). Two pts are still on treatment with AZA, 18 pts have died: 11 at home or at a hospice, 7 while hospitalized. The pts median survival time from the start of AZA was 143.2 days (range 5-284) for AML pts and 229.7 days (range 49-411) for MDS pts.
Conclusion
Home administration of AZA proved feasible through the availability of a domiciliary service that guaranteed a high number of transfusions, blood sampling and i.v. antimicrobial therapy, combined with an approach of palliative care. Pts with poor prognosis AML/MDS had the opportunity of undergoing a specific epigenetic treatment at home, while living a considerable time interval outside the hospital with a high satisfaction level for HC. Inappropriate hospitalizations were reduced, with an overall median time at home of nearly 5 months for AML and 7.6 months for MDS pts. Death during the hospice care occurred in 61% of cases.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Histone deacetylase inhibitor, MDS/AML, Myeloid malignancies
Abstract: PB1660
Type: Publication Only
Background
Home delivery of parenteral antineoplastic agents may allow an appropriate treatment for frail or disable patients (pts) with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS), whose management would be otherwise hampered by clinical barriers or conditioned by hospitalization requirements.
Aims
To describe the feasibility of a home care (HC) program that provides a managing package capable of supporting pts with their parenteral AZA therapy at home.
Methods
A retrospective analysis of the clinical features, use of resources, follow-up and HC satisfaction rating of frail homebound pts affected by AML or intermediate-high risk MDS with a clinical frailty scale score >4, who received at home subcutaneous AZA (75 mg/sqm/7 days).
Results
Overall, 106 pts with AML/MDS received AZA therapy; in 13 out of 31 pts (4%) with AML and in 7 out of 75 pts (9%) with MDS, the drug was administered at home. Reasons for the HC solution were: i) disability in 15 pts (11 AML/4 MDS), ii) early discharge from the ward in 5 (2 AML/3 MDS). The pts’ median age was 76 yrs (range 59-83), Karnofsky PS 50% (range 40-60%), Activity Dayly Living score 4 (range 1-6), Charlson co-morbidity index 2 (range 1-3). The mean No. of AZA courses in AML and MDS patients was 3 (1-6) and 2 (1-4), respectively. At home, 409 units of packed red cells were transfused, with a mean No. of 20 units transfused/per patient (range 0-94). During AZA therapy, 13 pts had infections with a mean No. of infections/patient of 1.9 (range 0-7). In 37 out of 38 cases (97%), infections were managed at home with i.v. antibiotic administration. Overall, hospitalization occurred in 8 out of 20 pts (40%). AZA therapy at home was started as a first course in 6 pts, whereas it was continued in 14 pts following courses already delivered at hospital, with a mean No. of 2.8 courses (range 1-4) and 2.1 (range 1-6), administered respectively. In 83% of cases, pts rated HC as more than good. Eighteen pts discontinued HC AZA: 15 due to disease progression and 3 because of an infection-related hospitalization. The median length of HC after AZA interruption was 111 days (1-343). Two pts are still on treatment with AZA, 18 pts have died: 11 at home or at a hospice, 7 while hospitalized. The pts median survival time from the start of AZA was 143.2 days (range 5-284) for AML pts and 229.7 days (range 49-411) for MDS pts.
Conclusion
Home administration of AZA proved feasible through the availability of a domiciliary service that guaranteed a high number of transfusions, blood sampling and i.v. antimicrobial therapy, combined with an approach of palliative care. Pts with poor prognosis AML/MDS had the opportunity of undergoing a specific epigenetic treatment at home, while living a considerable time interval outside the hospital with a high satisfaction level for HC. Inappropriate hospitalizations were reduced, with an overall median time at home of nearly 5 months for AML and 7.6 months for MDS pts. Death during the hospice care occurred in 61% of cases.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Histone deacetylase inhibitor, MDS/AML, Myeloid malignancies
Type: Publication Only
Background
Home delivery of parenteral antineoplastic agents may allow an appropriate treatment for frail or disable patients (pts) with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS), whose management would be otherwise hampered by clinical barriers or conditioned by hospitalization requirements.
Aims
To describe the feasibility of a home care (HC) program that provides a managing package capable of supporting pts with their parenteral AZA therapy at home.
Methods
A retrospective analysis of the clinical features, use of resources, follow-up and HC satisfaction rating of frail homebound pts affected by AML or intermediate-high risk MDS with a clinical frailty scale score >4, who received at home subcutaneous AZA (75 mg/sqm/7 days).
Results
Overall, 106 pts with AML/MDS received AZA therapy; in 13 out of 31 pts (4%) with AML and in 7 out of 75 pts (9%) with MDS, the drug was administered at home. Reasons for the HC solution were: i) disability in 15 pts (11 AML/4 MDS), ii) early discharge from the ward in 5 (2 AML/3 MDS). The pts’ median age was 76 yrs (range 59-83), Karnofsky PS 50% (range 40-60%), Activity Dayly Living score 4 (range 1-6), Charlson co-morbidity index 2 (range 1-3). The mean No. of AZA courses in AML and MDS patients was 3 (1-6) and 2 (1-4), respectively. At home, 409 units of packed red cells were transfused, with a mean No. of 20 units transfused/per patient (range 0-94). During AZA therapy, 13 pts had infections with a mean No. of infections/patient of 1.9 (range 0-7). In 37 out of 38 cases (97%), infections were managed at home with i.v. antibiotic administration. Overall, hospitalization occurred in 8 out of 20 pts (40%). AZA therapy at home was started as a first course in 6 pts, whereas it was continued in 14 pts following courses already delivered at hospital, with a mean No. of 2.8 courses (range 1-4) and 2.1 (range 1-6), administered respectively. In 83% of cases, pts rated HC as more than good. Eighteen pts discontinued HC AZA: 15 due to disease progression and 3 because of an infection-related hospitalization. The median length of HC after AZA interruption was 111 days (1-343). Two pts are still on treatment with AZA, 18 pts have died: 11 at home or at a hospice, 7 while hospitalized. The pts median survival time from the start of AZA was 143.2 days (range 5-284) for AML pts and 229.7 days (range 49-411) for MDS pts.
Conclusion
Home administration of AZA proved feasible through the availability of a domiciliary service that guaranteed a high number of transfusions, blood sampling and i.v. antimicrobial therapy, combined with an approach of palliative care. Pts with poor prognosis AML/MDS had the opportunity of undergoing a specific epigenetic treatment at home, while living a considerable time interval outside the hospital with a high satisfaction level for HC. Inappropriate hospitalizations were reduced, with an overall median time at home of nearly 5 months for AML and 7.6 months for MDS pts. Death during the hospice care occurred in 61% of cases.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Histone deacetylase inhibitor, MDS/AML, Myeloid malignancies
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