Skip to main content

Advertisement

SpringerLink
Log in

Characterization of a multidisciplinary team’s role in hospital discharge for patients receiving hypomethylating agents with venetoclax as induction therapy for acute myeloid leukemia

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Venetoclax combined with a hypomethylating agent (HMA) has become the standard of care for elderly/unfit patients with newly diagnosed acute myeloid leukemia (AML). This study is aimed at characterizing the impact of an interdisciplinary team on the length of stay (LOS) of patients with newly diagnosed AML receiving venetoclax with an HMA.

Methods

This retrospective observational study included patients with AML who received HMA with venetoclax as an initial treatment between December 2015 and July 2021. The primary outcome was the median LOS during induction stratified by HMA. Secondary outcomes included barriers to hospital discharge, incidence of tumor lysis syndrome (TLS), response rates, and utilization of the institution’s prescription assistance program (PAP).

Results

Seventy-eight patients were included in our analysis: 51 received azacitidine/venetoclax, and 27 received decitabine/venetoclax. The median LOS from therapy initiation was eight days (range 7–38) for the azacitidine group and six days (range 5–26) for the decitabine group. The most common barriers to discharge were transfusion dependence (33 patients, 42.3%) and insurance coverage (12 patients, 15.4%). Twelve patients (15.3%) had tumor lysis syndrome during hospital admission, and 20 (25.6%) were readmitted during induction. Twenty-three patients (29.5%) required financial assistance for AML care, and a pharmacy-led PAP generated approximately $342,646 in cost savings.

Conclusion

The utilization of an interdisciplinary AML team to target early hospital discharge proved to be safe and effective and led to a reduction in costs for the health system. Future research may identify select patients who may be suitable for earlier discharge or outpatient induction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

These clinical trial data can be requested by qualified researchers who engage in rigorous, independent scientific research and will be provided following review and approval of a research proposal, statistical analysis plan (SAP), and execution of a data sharing agreement (DSA). Data requests can be submitted at any time, and the data will be accessible for 12 months with possible extensions considered.

References

  1. Acute Myeloid Leukemia Treatment (PDQ®). NIH National Cancer Institute. https://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq. Published 2021. Accessed 25 Sept 2021

  2. Leukemia - acute myeloid - AML: statistics. https://www.cancer.net/cancer-types/leukemia-acute-myeloid-aml/statistics. Accessed 25 Sept 2021

  3. DiNardo CD, Jonas BA, Pullarkat V et al (2020) Azacitidine and venetoclax in previously untreated acute myeloid leukemia. N Engl J Med 383(7):617–629. https://doi.org/10.1056/NEJMoa2012971

    Article  CAS  PubMed  Google Scholar 

  4. Altman JK, Lurie RH, Appelbaum FR et al (2021) NCCN guidelines acute myeloid leukemia (age ≥ 18 years). NCCN 3.2021

  5. DiNardo CD, Maiti A, Rausch CR et al (2020) 10-day decitabine with venetoclax for newly diagnosed intensive chemotherapy ineligible, and relapsed or refractory acute myeloid leukaemia: a single-centre, phase 2 trial. Lancet Haematol 7(10):e724–e736. https://doi.org/10.1016/S2352-3026(20)30210-6

    Article  PubMed  PubMed Central  Google Scholar 

  6. DiNardo CD, Pratz K, Pullarkat V et al (2019) Venetoclax combined with decitabine or azacitidine in treatment-naive, elderly patients with acute myeloid leukemia. Blood 133(1):7–17. https://doi.org/10.1182/blood-2018-08-868752

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. DiNardo CD, Pratz KW, Letai A et al (2018) Safety and preliminary efficacy of venetoclax with decitabine or azacitidine in elderly patients with previously untreated acute myeloid leukaemia: a non-randomised, open-label, phase 1b study. Lancet Oncol 19(2):216–228. https://doi.org/10.1016/S1470-2045(18)30010-X

    Article  CAS  PubMed  Google Scholar 

  8. Roberts AW, Davids MS, Pagel JM et al (2016) Targeting BCL2 with venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med 374(4):311–322. https://doi.org/10.1056/NEJMoa1513257

    Article  CAS  PubMed  Google Scholar 

  9. Talati C, Sweet KL, Pollyea DA et al (2021) Moving the treatment of acute myeloid leukemia to the outpatient setting : current expert perspectives and consensus findings. J Clin Hematol 2(3):86–94

    Google Scholar 

  10. Wyatt H, Zuckerman AD, Hughes ME, Arnall J, Miller R (2022) Addressing the challenges of novel oncology and hematology treatments across sites of care: specialty pharmacy solutions. J Oncol Pharm Pract 28(3):627–634. https://doi.org/10.1177/10781552211072467

    Article  PubMed  Google Scholar 

  11. Anders B, Shillingburg A, Newton M (2015) Oral antineoplastic agents: assessing the delay in care. Chemother Res Pract 2015:512016. https://doi.org/10.1155/2015/512016

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Niccolai JL, Roman DL, Julius JM, Nadour RW (2017) Potential obstacles in the acquisition of oral anticancer medications. J Oncol Pract 13(1):e29–e36. https://doi.org/10.1200/JOP.2016.012302

    Article  PubMed  Google Scholar 

  13. Jonas BA, Pollyea DA (2019) How we use venetoclax with hypomethylating agents for the treatment of newly diagnosed patients with acute myeloid leukemia. Leukemia 33(12):2795–2804. https://doi.org/10.1038/s41375-019-0612-8

    Article  CAS  PubMed  Google Scholar 

  14. Pabon CM, Li Z, Hennig T et al (2021) Morphologic leukemia-free state in acute myeloid leukemia is sufficient for successful allogeneic hematopoietic stem cell transplant. Blood Cancer J 11(5):92. https://doi.org/10.1038/s41408-021-00481-9

    Article  PubMed  PubMed Central  Google Scholar 

  15. Foundation KF. Hospital adjusted expenses per inpatient day by ownership. https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day-by-ownership/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Published 2021. Accessed 25 Apr 2022

  16. Walter RB, Lee SJ, Gardner KM et al (2011) Outpatient management following intensive induction chemotherapy for myelodysplastic syndromes and acute myeloid leukemia: a pilot study. Haematologica 96(6):914–917. https://doi.org/10.3324/HAEMATOL.2011.040220

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Moore NJ, Othus M, Halpern AB et al (2021) Financial implications of early hospital discharge after AML-like induction chemotherapy: a 4-year retrospective analysis. J Natl Compr Cancer Netw 1(aop):1–10. https://doi.org/10.6004/JNCCN.2020.7683

  18. Zhang H, Yu J, Wei Z, Wu W, Zhang C, He Y (2021) The effect of multidisciplinary team discussion intervention on the prognosis of advanced colorectal cancer. J Cancer 12(11):3307. https://doi.org/10.7150/JCA.56171

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Horvath LE, Yordan E, Malhotra D et al (2010) Multidisciplinary care in the oncology setting: historical perspective and data from lung and gynecology multidisciplinary clinics. J Oncol Pract 6(6). https://doi.org/10.1200/JOP.2010.000073

  20. Parker C, Berkovic D, Wei A, Zomer E, Liew D, Ayton D (2021) “If i don’t work, i don’t get paid”: an Australian qualitative exploration of the financial impacts of acute myeloid leukaemia. Health Soc Care Community. https://doi.org/10.1111/HSC.13642

    Article  PubMed  Google Scholar 

  21. Bewersdorf JP, Shallis RM, Wang R et al (2019) Healthcare expenses for treatment of acute myeloid leukemia. 101080/1747408620191627869 12(8):641–650. https://doi.org/10.1080/17474086.2019.1627869

  22. Jeong AY, Schwartz EB, Roman AR et al (2022) Characterizing out-of-pocket payments and financial assistance for patients prescribed abiraterone and enzalutamide at an academic cancer center specialty pharmacy. JCO Oncol Pract 18(2):e284–e292. https://doi.org/10.1200/op.21.00168

    Article  PubMed  Google Scholar 

  23. Apel A, Moshe Y, Ofran Y et al (2021) Venetoclax combinations induce high response rates in newly diagnosed acute myeloid leukemia patients ineligible for intensive chemotherapy in routine practice. Am J Hematol 96(7):790–795. https://doi.org/10.1002/AJH.26190

    Article  CAS  PubMed  Google Scholar 

  24. Feld J, Tremblay D, Dougherty M et al (2021) Safety and efficacy: clinical experience of venetoclax in combination with hypomethylating agents in both newly diagnosed and relapsed/refractory advanced myeloid malignancies. HemaSphere. https://doi.org/10.1097/HS9.0000000000000549

    Article  PubMed  PubMed Central  Google Scholar 

  25. Keruakous A, Saleem R, Asch AS (2020) Venetoclax-induced tumor lysis syndrome in acute myeloid leukemia: real world experience. 101200/JCO20203815_suppl.e19542. 38(15_suppl):e19542-e19542. https://doi.org/10.1200/JCO.2020.38.15_SUPPL.E19542

  26. Pelcovits A, Moore J, Bakow B, Niroula R, Egan P, Reagan JL (2021) Tumor lysis syndrome risk in outpatient versus inpatient administration of venetoclax and hypomethlators for acute myeloid leukemia. Support Care Cancer 29(9):5323–5327. https://doi.org/10.1007/S00520-021-06119-7/TABLES/2

    Article  PubMed  Google Scholar 

  27. Winters AC, Gutman JA, Purev E et al (2019) Real-world experience of venetoclax with azacitidine for untreated patients with acute myeloid leukemia. Blood Adv 3(20):2911–2919. https://doi.org/10.1182/BLOODADVANCES.2019000243

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Azacitidine, venetoclax, and gilteritinib in treating patients with recurrent/refractory FLT3-mutated acute myeloid leukemia, chronic myelomonocytic leukemia, or high-risk myelodysplastic syndrome/myeloproliferative neoplasm. https://clinicaltrials.gov/ct2/show/NCT04140487?term=gilteritinib+azacitidine+venetoclax&draw=2&rank=1. Accessed 29 May 2022

Download references

Acknowledgements

Figure 1 was created with BioRender.com.

Author information

Authors and Affiliations

  1. Department of Pharmacy, University of California Davis Medical Center, Sacramento, CA, USA

    Vera Pervitsky, Julie Guglielmo & Benjamin Moskoff

  2. University of California, San Francisco School of Pharmacy, San Francisco, CA, 94143, USA

    Julie Guglielmo, Benjamin Moskoff & Ryan Beechinor

  3. UC Davis Comprehensive Cancer Center, 2279 45th Street, CA, 95817, Sacramento, USA

    Roxie Kneen, Carol Leija, Deborah Sawicky, Brian A. Jonas & Ryan Beechinor

  4. Department of Internal Medicine, Division of Malignant Hematology, Cellular Therapy and Transplantation, University of California Davis School of Medicine, Sacramento, CA, 95817, USA

    Roxie Kneen & Brian A. Jonas

  5. Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA

    Margaret Li Krackeler

Authors
  1. Vera Pervitsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie Guglielmo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin Moskoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roxie Kneen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carol Leija
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Deborah Sawicky
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Margaret Li Krackeler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brian A. Jonas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ryan Beechinor
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, B.A.J. and R.J.B.; data curation, V.P. and R.J.B.; writing—original draft preparation, V.P. and R.J.B.; writing—review and editing, V.P., B.M., J.G., R.K., C.L., D.S., M.K. B.A.J., and R.J.B.; supervision, B.A.J. and R.J.B. All the authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Ryan Beechinor.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All the study procedures were approved by our Institutional Review Board, and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

Brian A Jonas reports consultant/advisor following entities which are unrelated to this content: AbbVie, BMS, Genentech, Gilead, GlycoMimetics, Jazz, Pfizer, Servier, Takeda, Tolero, and Treadwell; protocol steering committee for GlycoMimetics; data monitoring committee for Gilead; travel reimbursement from AbbVie; and research funding to his institution from 47, AbbVie, Accelerated Medical Diagnostics, Amgen, Aptose, AROG, BMS, Celgene, Daiichi Sankyo, F. Hoffmann-La Roche, Forma, Genentech/Roche, Gilead, GlycoMimetics, Hanmi, Immune-Onc, Incyte, Jazz, Loxo Oncology, LP Therapeutics, Pfizer Inc., Pharmacyclics, Sigma Tau, and Treadwell. Ryan J Beechinor reports having received funding/compensation for consulting and/or research activities from the following entities which are unrelated to this content: National Institute of Health (NIH), Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD), Children’s Oncology Group (COG), IQVIA, Cempra Pharmaceutics, Oncology Reimbursement Management, Aptitude Health, The Dedham Group, Trinity Life Sciences, and Pfizer Inc. All remaining authors report no conflicts of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pervitsky, V., Guglielmo, J., Moskoff, B. et al. Characterization of a multidisciplinary team’s role in hospital discharge for patients receiving hypomethylating agents with venetoclax as induction therapy for acute myeloid leukemia. Support Care Cancer 31, 224 (2023). https://doi.org/10.1007/s00520-023-07664-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-07664-z

Keywords

Search

Navigation