Does time from diagnosis to treatment affect the prognosis of patients with newly diagnosed acute myeloid leukemia?

Abstract

In fit patients with newly diagnosed acute myeloid leukemia (AML), immediate treatment start is recommended due to the poor prognosis of untreated acute leukemia. We explored the relationship between the time from diagnosis to treatment start (TDT) and prognosis in a large set of real-world data from the German SAL-AML registry. All registered non-APL patients from the registry with intensive induction treatment and a minimum follow-up time of 12 months were selected (n=2,263). We analyzed the influence of TDT on remission, early death and overall survival (OS) in univariable analyses for each day of treatment delay, in groups of 0-5, 6-10, 11-15 and >15 days of TDT, and adjusted for the influence of established prognostic variables on the outcomes. The median TDT was 3 days (IQR 2-7). The unadjusted 2-y OS rates stratified by TDT of 0-5, 6-10, 11-15, >15 days were 51, 48, 44, and 50% (p=0.211). In multivariable Cox regression analysis accounting for established prognostic variables, the HR for TDT as continuous variable was 1.00 (p=0.617). When OS was analyzed separately stratified for age ≤60 and >60 ys and for high versus lower initial WBC, no significant differences between TDT groups were observed. Our study suggests that TDT is not related to survival. As treatment stratification in intensive first-line treatment of AML evolves, the TDT data suggests that it may be a feasible approach to wait for genetic and other laboratory test results in order to assign clinically stable patients to the best available treatment option.

Determination of fitness and therapeutic options in older patients with acute myeloid leukemia

“…In the clinical management of newly diagnosed AML, immediate treatment start is typically recommended due to poor prognosis. However, more recently, a real‐world analysis from the German Study Alliance Leukemia–Acute Myeloid Leukemia registry arrived at a different conclusion 35 . In this large analysis of 2263 AML patients who received intensive induction therapy (median age: 59 years; de novo AML: 75%; secondary AML: 15%), time from diagnosis to treatment did not affect the likelihood of response, early death, or long‐term survival.…”

Strategizing the Treatment Approach to Acute Myeloid Leukemia

“…A large retrospective analysis of 2263 patients showed that time to treatment did not significantly affect disease remission or survival [6]. The main complications contributing to early mortality after diagnosis are neutropenic infections, bleeding complications and leukostasis, with a median survival of 17 weeks if untreated [6,7]. Improvements in management have decreased mortality related to these complications allowing for an increase in time from diagnosis to treatment.…”

Therapy for acute myelogenous leukemia revisited: moving away from a one-size-fits-all approach

“…An important challenge in this regard is the immediate need for results from genetic testing before starting of treatment. Whether waiting from the initial diagnosis to the start of treatment is justifiable for the patients, has been a controversial topic, with some conflicting study results [16,17]. Most clinicians will likely strive for both rapid and punctual diagnosis and treatment, and considerations for new treatment possibilities will be a careful assessment of both the biology of disease and of the patient's physical condition and expectations for treatment.…”