Published on June 17, 2020
Acute myeloid leukemia (AML) is a malignant stem cell disease of the bone marrow. Untreated, it can lead to a poor prognosis, but what about delayed treatment? Is there a relationship between the time from diagnosis to first treatment when predicting outcomes in patients with AML?
Researchers reviewed the Clinical AML Registry and Biomaterial Database of the Study Alliance Leukemia to answer this question. They reviewed data for 2,263 patients and analyzed the influence of time between diagnosis and first treatment on remission, early death and overall survival (OS).
This study of patients suggests that time to treat is not related to survival in fit patients with previously untreated AML1, which rivals a study from 2009. The earlier study concluded that younger patients (60 years old or younger) can delay treatment while waiting for test results, but waiting is dangerous for older patients who, ideally, should start treatment right away.2
While some cancer types have a standard of care, due to the numerous variables in the number of genetic mutations with AML, it is even more of a puzzle to solve. Your medical team should evaluate your individual case and weigh the risk versus reward of starting treatment immediately rather than waiting for further tests. Every patient is unique, and their cancer care should be, too.
Fit Versus Unfit
With the numerous therapies that have become available in recent years, the new challenge is figuring out which patients should get certain therapies. AML specialists have started factoring in a patient’s fitness level when considering treatment options. In this context, what does ‘fit’ even mean?
“A lot of that is really determined on the basis of whether your doctor feels your organ function is adequate enough to tolerate really risky high-dose therapy but then also whether or not you are kind of physically fit, up and about doing things,” said Dr. Thomas LeBlanc, a medical oncologist, palliative care physician and patient experience researcher at Duke Cancer Institute.
The more a patient is able to get up and move around, perhaps engage in exercise, is more of a determinant than, say, age in deciding who can safely undergo intensive treatments.
After determining fitness levels, testing for genetic mutations and biomarkers can also help your oncologist decide the best course of treatment for you.
Dr. LeBlanc recently spoke in depth about this topic during a Patient Power interview. Watch AML Breakthrough Therapies to learn how AML specialists personalize patient care based on fitness.
Testing for Genetic Mutations
An AML diagnosis is often a race against the clock but knowing your genetic mutations is important, too. There is a delicate balance between starting treatment right away and getting tested first to make sure you’re getting the precise therapy you need.
So, when is the ideal time to test for mutations?
Dr. Naval Daver, Assistant Professor, Department of Leukemia, at The University of Texas MD Anderson Cancer Center, recently answered this question in a Patient Power discussion about AML mutations.
“This is an important question in acute myeloid leukemia therapy,” said Dr. Daver. “We have had a lot of progress over the last two or three years in identifying targeted therapies, and it is very important to look for particular mutations."
“In my view, and at MD Anderson as well as large academic centers across the United States and now the world, the baseline or newly diagnosed time point is probably the most important time to check for mutations.”
Dr. Daver went on to say that the second important point to check for mutations is at the time of relapse.
AML can be an overwhelming diagnosis. Fortunately, there are exciting new therapies already available and more being studied in clinical trials. With advances in personalized therapy, recent FDA approvals, and ongoing research, AML patients and their loved ones have more reasons than ever to be hopeful about the future.
As always, we’re here to bring you the latest and most important information. Want to learn more about AML? Sign up for e-news and we’ll send it directly to your inbox.
~Lauren Evoy Davis
Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.
- Röllig C, et al. Does time from diagnosis to treatment affect the prognosis of patients with newly diagnosed acute myeloid leukemia? Blood. June 4, 2020.
- Sekeres MA, et al. Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia patients. Blood (2009) 113 (1): 28–36.
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