67yo otherwise healthy woman who is in scheduled to close on her house and move out of state soon. She went to her PCP here for basic checkup because she knew it would take her awhile to find a doctor when she moves. She was pancytopenic and marrow shows AML, awaiting remainder of details. She's feeling well at the moment but I emphasized the urgent nature of her situation. I suspect she is just hoping she can do nothing until she closes on her house soon. She is transplant eligible and needs induction. The closest transplant center where she's moving is over an hour away. I'm trying to help her make arrangements but just wondering if there is any treatment I can safely give outpatient while she tries to figure out where she wants to be treated. Aza maybe?
She’ll likely require treatment within the next month and it may take her that long to establish care. How cytopenic is she? Definitely can buy time with an HMA assuming her AML isn’t too aggressive. Other option would be to start HMA and venetoclax, though this may require closer monitoring and more likely to need transfusions. If she’s unable to come in for all the HMA days can do oral decitabine with Inqovi or try LDAC injections at home if she’s willing to try those. HMA+Ven would likely be best option if you think her counts could tolerate it, could perhaps only give 7-14 days to try and prevent cytopenias, but all of these are imperfect options likely.
