Infectious Morbidity and Hospitalization Requirements of Patients with Acute Myeloid Leukemia Receiving Intensive Outpatient Consolidation.
Notice bibliographique
Résumé
Abstract Limited inpatient resources have focused interest upon the outpatient administration of intensive post-remission consolidation of acute myeloid leukemia (AML). Experience is limited in this regard (Blood 2002, 100:766a). In August 2001 a program of post-remission outpatient consolidation was instituted in our centre. A total of 68 cycles were administered to 35 patients with AML over 36 months. Standard prophylaxis included ciprofloxacillin and acyclovir. Our study was designed to look at infectious complications and requirement for hospitalization. Median age of patients was 54.5 years (range 20–77). Chemotherapy consisted of either high-dose cytarabine (1.5gm/m2 q12 hours x 12 doses in patients < 60 yrs) in 39 cycles, or intermediate-dose cytarabine (0.5gm/m2 q12 hours x 12 doses in patients >60 yrs) in 29. Upon completion of chemotherapy, patients continued to be evaluated daily on an ambulatory basis. Granulocyte colony stimulating factor was initiated on day eight of each cycle, along with blood product support. Median time to an absolute neutrophil count of ≥0.5 x 109/L, was 19.8 days (15–35). Only 26/68 (38%) required admission, with a median hospital stay of 19.7 days (5–96). A febrile neutropenic event (FNE) occurred in 46/68 (68%) cycles of outpatient consolidation, with blood cultures revealing a causative microorganism in 27/46 (59%). Viridans group Streptococci were the most common pathogen isolated, accounting for 12 cases, while Gram negative organisms were found in 5 patients. 15/46 (33%) patients were admitted to hospital at the onset of their FNE with 3 requiring inotropic support and endotracheal intubation. All three had septic shock and acute respiratory distress syndrome with documented Streptococcus mitis bacteremia; one of these patients died while the other two recovered fully. 31/46 (67%) cases of FNE were treated initially with outpatient antimicrobial therapy. The most commonly used empiric antibiotic regimen was vancomycin and ceftriaxone. 23/46 (50%) episodes of FNE were treated entirely on an outpatient basis; 8/46 (17%) failed outpatient antibiotics and required some inpatient care. Three patients were admitted for reasons other than FNE (psychosocial support, 1; relapse of AML, 1; central venous catheter infection, 1). Overall mean duration of hospitalization for each cycle of consolidation given was 7.5 days. The mortality of 2.9% seen in our group compares favorably with other published data (NEJM, 1994; 331:896). In conclusion intensive outpatient consolidation for AML is feasible, as it is associated with acceptable infectious morbidity, with the majority of cases (62% of cycles) being managed entirely on an ambulatory basis. The short mean duration of hospitalization of only 7.5 days per cycle, compares favorably with published data (NEJM 1995 332:217) and is likely economically advantageous. A comprehensive cost-analysis of outpatient versus inpatient costs for AML consolidation is under evaluation at our institution.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».