Background: Early hospital discharge (EHD) after intensive acute myeloid leukemia (AML) induction chemotherapy has become routine at the University of Washington/Seattle Cancer Care Alliance over the past several years. We assessed the financial implications of EHD over the first 4 years after its broad adoption for patients with AML and other high-grade myeloid neoplasms undergoing AML-like induction chemotherapy. Patients and Methods: We retrospectively compared charges between 189 patients with EHD who received all postinduction inpatient/outpatient care within our care system between August 2014 and July 2018 and 139 medically matched control patients who remained hospitalized for logistical reasons. Charges from the day of initial discharge (patients with EHD) or end of chemotherapy (control patients) until blood count recovery, additional chemotherapy or care transition, hospital discharge (for control patients only), an elapse of 42 days, or death were extracted from financial databases and separated into categories: facility/provider, emergency department, transfusions, laboratory, imaging, pharmacy, and miscellaneous. Results: Combined charges averaged $4,157/day (range, $905–$13,119/day) for patients with EHD versus $9,248/day (range, $4,363–$48,522/day) for control patients (P<.001). The EHD cohort had lower mean facility/provider, transfusion, laboratory, and pharmacy charges but not imaging or miscellaneous charges. During readmissions, there was no statistically significant difference in daily inpatient charges between the EHD and control cohorts. After multivariable adjustment, average charges were $3,837/day lower for patients with EHD (P<.001). Conclusions: Together with previous data from our center showing that EHD is safe and associated with reduced healthcare resource utilization, this study further supports this care approach for AML and other high-grade myeloid neoplasms if infrastructure is available to enable close outpatient follow-up.
Nathan J. Moore, Megan Othus, Anna B. Halpern, Nicholas P. Howard, Linyi Tang, Kyle E. Bastys, Mary-Elizabeth M. Percival, Paul C. Hendrie, Garrett A. Hartley, Verna L. Welch, Elihu H. Estey, and Roland B. Walter
Featured Updates to the NCCN Guidelines
Daniel A. Pollyea, Dale Bixby, Alexander Perl, Vijaya Raj Bhatt, Jessica K. Altman, Frederick R. Appelbaum, Marcos de Lima, Amir T. Fathi, James M. Foran, Ivana Gojo, Aric C. Hall, Meagan Jacoby, Jeffrey Lancet, Gabriel Mannis, Guido Marcucci, Michael G. Martin, Alice Mims, Jadee Neff, Reza Nejati, Rebecca Olin, Mary-Elizabeth Percival, Thomas Prebet, Amanda Przespolewski, Dinesh Rao, Farhad Ravandi-Kashani, Paul J. Shami, Richard M. Stone, Stephen A. Strickland, Kendra Sweet, Pankit Vachhani, Matthew Wieduwilt, Kristina M. Gregory, Ndiya Ogba, and Martin S. Tallman
The NCCN Guidelines for Acute Myeloid Leukemia (AML) provide recommendations for the diagnosis and treatment of adults with AML based on clinical trials that have led to significant improvements in treatment, or have yielded new information regarding factors with prognostic importance, and are intended to aid physicians with clinical decision-making. These NCCN Guidelines Insights focus on recent select updates to the NCCN Guidelines, including familial genetic alterations in AML, postinduction or postremission treatment strategies in low-risk acute promyelocytic leukemia or favorable-risk AML, principles surrounding the use of venetoclax-based therapies, and considerations for patients who prefer not to receive blood transfusions during treatment.