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How Time From Admission to Treatment Initiation Impacts AML Outcomes

November 19, 2018

Patients with acute myeloid leukemia (AML) who were treated in a tertiary care referral center more than 4 days after admission had a lower overall survival (OS) and event-free survival (EFS) compared with patients treated within 4 days of admission.

The time from diagnosis of AML to initiation of treatment may have an effect on patient outcomes. However, previous studies have yielded inconclusive results on this association.

Sami Ibrahimi, MD, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, and colleagues conducted a study to analyze the impact of the time from admission to treatment initiation on OS and EFS in patients who were newly diagnosed with AML. The study was designed as a retrospective review of the records of all newly-diagnosed AML cases treated at the University of Oklahoma Health Sciences Center from January 2000 through June 2015.

Other inclusion criteria were age 18 years or older and available insurance data. Patient characteristics, laboratory values, pathology, treatment, response, and survival data were obtained from the electronic medical records.

Results of the analysis were published in The Journal of Community and Supportive Oncology (2018;16(5):e188-e193).

A total of 154 patients were included in the study, of whom 109 had a time from admission to treatment initiation within 4 days and 45 of whom had a time from admission to treatment initiation of more than 4 days.

Dr Ibrahimi and colleagues reported that the median OS of the groups of patients was 1.3 years and 0.57 years, respectively (P = .0207). Similarly, the median EFS of the groups of patients was 1.21 years and 0.57 years, respectively (P = .0392).


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A multivariate analysis adjusting for age, white blood cell count, molecular risk group, and receipt of allogeneic stem cell transplant confirmed the significance of these associations.

“In conclusion, we found that treatment delays are associated with inferior outcomes in AML patients,” authors of the study concluded. “It remains to be elucidated whether the benefit gained from using targeted and less-intensive chemotherapy, especially in elderly patients, outweighs the potential harm from delaying treatment.”

Dr Ibrahimi and colleagues acknowledged multiple study limitations: small sample size and short median follow-up time.—Zachary Bessette

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