Time from diagnosis to intensive chemotherapy initiation does not adversely impact the outcome of patients with acute myeloid leukemia
A partir de données portant sur 599 patients traités par une chimiothérapie d'induction pour une leucémie myéloïde aiguë entre 2000 et 2009, cette étude française évalue l'association entre la durée de la période séparant le diagnostic du début de traitement, pour mener les tests nécessaires au choix de la stratégie thérapeutique, et la survie des patients
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 the years 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 (IQR, 4-16) and was significantly longer in patients with white blood cell count (WBC) less than 50 G/L (p<0.0001) and in older patients (p=0.0004). In multivariate analysis, TDT had no impact on overall survival (p=0.4095) as compared to age older than 60, secondary AML, WBC higher than 50 G/L, European LeukemiaNet risk groups and ECOG 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.
Blood , résumé, 2013