Remote Temperature Monitoring May Detect Fever Earlier After HiDAC for AML

The REMEDY trial evaluated the efficacy of remote continuous temperature monitoring (CTM) in patients receiving cytotoxic chemotherapy for acute myeloid leukemia (AML). The results were presented as a poster at the Hematology/Oncology Pharmacy Association Annual Conference 2024.

Fever is an early and important sign of infection in patients with febrile neutropenia (FN), so early recognition of fever is critical in this population. The REMEDY trial assessed CTM to identify fever in the ambulatory setting among patients with AML who were undergoing treatment with high-dose cytarabine (HiDAC), which is a therapy associated with a high risk of FN.

The trial compared a prospective, interventional cohort with data from a retrospective, preintervention cohort that did not use the CTM device. Conducted at a single center, the study enrolled adult patients with AML who received HiDAC as monotherapy. The CTM device utilized was the TempTraq, which consists of a wireless patch with an associated smart device application. Clinicians have access to the data, and alerts are sent to the patient and clinician when the patient’s temperature rises above 38 °C (100.4 °F). Patients were instructed to report to the emergency room (ER) in case of fever.

The retrospective cohort included 18 patients, and the intervention cohort included 12. Eleven (35.5%) patients in the retrospective cohort were admitted to the ER or hospital for FN, and 4 were transferred to the intensive care unit (ICU). Six patients assessed in the prospective cohort (50%) were admitted for FN, and no patients were admitted to the ICU. The median hospital length of stay was 7.05 days in the retrospective cohort and 4.10 days in the interventional cohort. Microbiologically defined infections were reported in 9 of 10 patients assessed in the retrospective cohort (90%) compared with no patients in the prospective cohort. No deaths occurred in either cohort.

“Results showed the CTM appeared to detect FN earlier, as evidenced by lower rates of documented infections, transfers to the ICU, and length of FN hospitalizations,” the authors wrote in their study.

Nine participants in the prospective cohort completed a questionnaire regarding use of the device. Eight patients reported at least 1 difficulty with the device, and 7 had at least 1 episode of a “no data transmission” alert being sent due to user error. “Consideration of access to broadband and literacy with technology is paramount for future success of a CTM device in the ambulatory care setting,” the authors noted.

In summary, the authors wrote, “Data from this single-center study suggest a CTM device may lead to a higher incidence of ER/hospital visits for FN but lower incidence of ICU transfer, confirmed infection source, and length of hospitalization for FN.” They called for larger studies to evaluate if CTM use was associated with better FN outcomes and decreased rates of chemotherapy complications.

Reference

Ketchum EB, Daniels S, Jimenez S, Mian M, Bryan L, Clemmons A. Remote outpatient temperature monitoring for early detection of febrile neutropenia after high-dose cytarabine consolidation chemotherapy (the REMEDY trial). Poster. Presented at the Hematology/Oncology Pharmacy Association Annual Conference 2024; April 3-6, 2024; Tampa, Florida.