An outpatient approach to the delivery of intensive consolidation chemotherapy to adults with acute lymphoblastic leukemia

Consolidation chemotherapy (CT) is important in the curative treatment of acute lymphoblastic leukemia (ALL). This therapy is intensive and toxic. Usually, more than 50% of the treatment period is spent in the hospital. To determine if CT could be given safely as outpatient (OP) treatment, this demonstration project included strict patient selection criteria, a multidisciplinary team, and protocols for teaching, symptom management, and transfusion support. Patients were hospitalized for the first course of CT. A right atrial catheter was placed, and patients were taught use of an ambulatory infusion pump and CT administration. Two patients treated on Southwest Oncology Group protocol 8417/19 have completed CT. No infections occurred, and patients had minimal CT side effects. Both patients experienced neutropenia, an expected complication, for 80 and 56 days. With careful patient selection and expert nursing support, intensive outpatient CT is possible with decreased hospitalizations and morbidity, and possible increased quality of life.