Evaluation of Early Discharge after Intensive Induction Chemotherapy in Adults with Acute Myeloid Leukemia

Background: Acute myeloid leukemia (AML) patients who require intensive induction chemotherapy are traditionally hospitalized for the duration of neutropenia to monitor for treatment-related toxicities. On average, AML patients are hospitalized for 33.7 days during first induction treatment (Sacks et al Clin Ther 2018). Prolonged hospitalizations are associated with substantial costs, increased risk for nosocomial infections, and significant declines in physical function and quality of life. Several studies have evaluated the impact of early discharge prior to neutrophil recovery, however current evidence has not clearly defined the ideal patient characteristics or described the optimal time post-induction to safely discharge patients. At our institution, we established a “STREAMLINE (Safe TRansition with Early-discharge in Acute Myeloid Leukemia INtensivE-induction) Protocol” to evaluate patients for early discharge following induction chemotherapy. Objective: To determine the optimal time after induction chemotherapy to safely discharge AML patients. Methods: Retrospective, single-institution review of adult AML patients who received intensive induction chemotherapy from January 1, 2017 to December 31, 2019. The STREAMLINE criteria for early discharge (Table 1) was retrospectively applied at discharge timepoint-1 (DT1) and discharge timepoint-2 (DT2). DT1 was defined as within 24 hours following completion of induction therapy and DT2 was defined as within 24 hours after performance of first bone marrow biopsy after induction therapy. Each patient served as his/her own control to compare actual length of hospitalization to the length of hospitalization if the patient had been discharged at DT1 and/or DT2. The primary outcome was number of hospital days saved if discharged at DT1 compared to DT2. Secondary outcomes included proportion of patients who met STREAMLINE criteria, incidence and time to first complication that would require hospital readmission for patients who met criteria, overall days of hospitalization, and overall survival at 30 and 60 days. Results: A total of 284 patients met inclusion criteria and were assessed for early discharge. Eighty-nine patients (31.3%) met the STREAMLINE criteria for early discharge with 51 (57.4%) at DT1, 19 (21.3%) at DT2, and 19 (21.3%) at DT1 and DT2. Baseline demographics of the study population are described in Table 2. Of the 195 patients (68.7%) ineligible for early discharge, 118 (60.5%) were ineligible