Effect of time of admission to treatment initiation on outcomes of patients with acute myeloid leukemia: a tertiary care referral center experience
Background The time from diagnosis of acute myeloid leukemia (AML) to initiation of treatment could affect patient outcomes, but findings from previous studies have been mixed.
Objective To analyze the impact of the time from adm ission to treatment initiation (TAT) on overall survival (OS) and event-free survival (EFS) in patients who are newly diagnosed with AML.
Methods A retrospective review of the records of all newly diagnosed AML patients treated at the Oklahoma University Health Sciences Center from January 2000 through June 2015 was conducted. Inclusion criteria also included age ≥18 years and available insurance data. Data on patient characteristics, laboratory values, pathology, treatment, response, and survival were obtained from the electronic medical records.
Results In all, 154 patients were divided into 2 groups: those with a TAT of 0-4 days (n = 109) and those with a TAT of >4 days (n = 45). The median OS of the TAT 0-4 days group and the TAT >4 days group was 1.3 years and 0.57 years, respectively(P = .0207), and the median EFS for the groups was 1.21 years and 0.57 years, respectively (P = .0392). That association remained significant in a multivariate analysis adjusting for age, white blood cell count, molecular risk group, and undergoing allogeneic stem cell transplant.
Limitations Study limitations include a small sample size and a short median follow-up time.
Conclusion Patients with AML who are treated more than 4 days after admission have a lower OS and EFS compared with patients treated within 0-4 days of admission.
Funding/sponsorship None
Accepted for publication September 13, 2018
Correspondence Sami Ibrahimi, MD; Sami-Ibrahimi@ouhsc.edu
Disclosures Cherry is on the advisory board of Gilead. The remaining authors report no disclosures or conflicts of interest.
Citation JCSO 2018;16(5):e188-e193
©2018 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0428
Acute myeloid leukemia (AML) is the most common acute leukemia in adults in the United States.1 In 2018, the estimated annual incidence of AML is 19,520 (32.4% of all new leukemia cases), with 10,670 projected deaths (43.8% of all leukemia deaths).1 New molecularly targeted treatments are increasingly being used in treating AML, and some of them have shown improved health outcomes. In general, age, white blood cell (WBC) count at presentation, cytogenetics, and molecular characteristics are the major determinants of prognosis and treatment outcome. Studies analyzing the Surveillance Epidemiology and End Results database have also shown racial differences in outcomes.2 It is well known to the oncology community that patients with similar characteristics may respond differently to treatment and that outcome is not uniformly related to the well-defined clinical and laboratory characteristics. Issues related to health care disparities and access to health care are also known to affect the outcome in patients with cancer.3-9
AML is generally considered by the medical community as a time-sensitive condition. Treatment of patients with AML usually consists of induction chemotherapy followed by consolidation treatment with consideration for stem cell transplant. The duration of time from admission to treatment (TAT) of AML with induction chemotherapy is dependent on multiple factors. These may include the assessment of comorbid conditions and the availability of molecular studies at the time of treatment, which can be time consuming. The effect of treatment delays after AML diagnosis has been investigated, but with conflicting results. One study showed that time from diagnosis to treatment initiation affects survival in younger patients, and another showed it has no effect on survival regardless of patient age.10,11 We describe here the results of a retrospective analysis evaluating the impact of TAT and day of admission on outcomes of patients with AML who received treatment at a tertiary care referral center.
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