Time from diagnosis to intensive chemotherapy initiation does not adversely impact the outcome of patients with acute myeloid leukemia

Blood. 2013 Apr 4;121(14):2618-26. doi: 10.1182/blood-2012-09-454553. Epub 2013 Jan 30.

Abstract

In acute myeloid leukemia (AML), new strategies assess the potential benefit of genetically targeted therapy at diagnosis. This implies waiting for laboratory tests and therefore a delay in initiation of chemotherapy. We studied the impact of time from diagnosis to treatment (TDT) on overall survival, early death, and response rate in a retrospective series of 599 newly diagnosed AML patients treated by induction chemotherapy between 2000 and 2009. The effect of TDT was assessed using multivariate analysis. TDT was analyzed as a continuous variable using a specific polynomial function to model the shape and form of the relationship. The median TDT was 8 days (interquartile range, 4-16) and was significantly longer in patients with a white blood cell count (WBC) <50 Giga per liter (G/L) (P < .0001) and in older patients (P = .0004). In multivariate analysis, TDT had no impact on overall survival (P = .4095) compared with age >60 years, secondary AML, WBC >50 G/L, European LeukemiaNet risk groups, and Eastern Cooperative Oncology Group performance status. Furthermore, TDT was not associated with response rate and early death. Thus, waiting a short period of time for laboratory tests to characterize leukemias better and design adapted therapeutic strategies at diagnosis seems possible.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibiotics, Antineoplastic / therapeutic use
  • Antimetabolites, Antineoplastic / therapeutic use
  • Cytarabine / therapeutic use*
  • Daunorubicin / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Idarubicin / therapeutic use*
  • Kaplan-Meier Estimate
  • Leukemia, Myeloid, Acute / diagnosis
  • Leukemia, Myeloid, Acute / drug therapy*
  • Leukemia, Myeloid, Acute / mortality*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Time-to-Treatment / statistics & numerical data*
  • Treatment Outcome
  • Young Adult

Substances

  • Antibiotics, Antineoplastic
  • Antimetabolites, Antineoplastic
  • Cytarabine
  • Idarubicin
  • Daunorubicin