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

• Published in: Blood 2013-04, Vol.121 (14), p.2618-2626
• Main Authors: Bertoli, Sarah, Bérard, Emilie, Huguet, Françoise, Huynh, Anne, Tavitian, Suzanne, Vergez, François, Dobbelstein, Sophie, Dastugue, Nicole, Mansat-De Mas, Véronique, Delabesse, Eric, Duchayne, Eliane, Demur, Cécile, Sarry, Audrey, Lauwers-Cances, Valérie, Laurent, Guy, Attal, Michel, Récher, Christian
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antibiotics, Antineoplastic; Antibiotics, Antineoplastic - therapeutic use; Antimetabolites, Antineoplastic; Antimetabolites, Antineoplastic - therapeutic use; Cancer; Cytarabine; Cytarabine - therapeutic use; Daunorubicin; Daunorubicin - therapeutic use; Female; Follow-Up Studies; Humans; Idarubicin; Idarubicin - therapeutic use; Kaplan-Meier Estimate; Leukemia, Myeloid, Acute; Leukemia, Myeloid, Acute - diagnosis; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - mortality; Life Sciences; Male; Middle Aged; Multivariate Analysis; Prognosis; Retrospective Studies; Risk Factors; Time-to-Treatment; Time-to-Treatment - statistics & numerical data; Treatment Outcome; Young Adult
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2012-09-454553

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) 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. •The prognostic impact of time from diagnosis to treatment in AML is offset by other factors such as age, secondary AML, or genetic abnormalities.•Waiting a short period of time to characterize leukemias better and design adapted treatments at diagnosis seems possible.