Does time from diagnosis to treatment affect the prognosis of patients with newly diagnosed acute myeloid leukemia?

被引：85

作者：

Roellig, Christoph ^{[1
]}

Kramer, Michael ^{[1
]}

Schliemann, Christoph ^{[2
]}

Mikesch, Jan-Henrik ^{[2
]}

Steffen, Bjoern ^{[3
]}

Kramer, Alwin ^{[4
,5
]}

Noppeney, Richard ^{[6
]}

Schaefer-Eckart, Kerstin ^{[7
]}

Krause, Stefan W. ^{[8
]}

Haenel, Mathias ^{[9
]}

Herbst, Regina ^{[9
]}

Kunzmann, Volker ^{[10
]}

Einsele, Hermann ^{[10
]}

Jost, Edgar ^{[11
]}

Bruemmendorf, Tim H. ^{[11
]}

Scholl, Sebastian ^{[12
]}

Hochhaus, Andreas ^{[12
]}

Neubauer, Andreas ^{[13
]}

Sohlbach, Kristina ^{[13
]}

Fransecky, Lars ^{[14
]}

Kaufmann, Martin ^{[15
]}

Niemann, Dirk ^{[16
]}

Schaich, Markus ^{[17
]}

Frickhofen, Norbert ^{[18
]}

Kiani, Alexander ^{[19
]}

Heits, Frank ^{[20
]}

Kruempelmann, Ulrich ^{[21
]}

Kaiser, Ulrich ^{[22
]}

Kullmer, Johannes ^{[23
]}

Wass, Maxi ^{[24
]}

Stoelzel, Friedrich ^{[1
]}

von Bonin, Malte ^{[1
]}

Middeke, Jan Moritz ^{[1
]}

Thiede, Christian ^{[1
]}

Schetelig, Johannes ^{[1
,25
]}

Berdel, Wolfgang E. ^{[2
]}

Ehninger, Gerhard ^{[1
]}

Baldus, Claudia D. ^{[13
]}

Muller-Tidow, Carsten ^{[4
]}

Platzbecker, Uwe ^{[26
]}

Serve, Hubert ^{[3
]}

Bornhaeuser, Martin ^{[1
]}

机构：

[1] Univ Klinikum Dresden, Med Klin & Poliklin 1, Dresden, Germany

[2] Univ Klinikum Munster, Med Klin A, Munster, Germany

[3] Klinikum JW Goethe Univ Frankfurt, Med Klin 2, Frankfurt, Germany

[4] Univ Klinikum Heidelberg, Med Klin 5, Heidelberg, Germany

[5] Deutsch Krebsforschungszentrum DKFZ, Heidelberg, Germany

[6] Univ Klinikum Essen, Klin Hamatol, Essen, Germany

[7] Paracelsus Med Privatuniv Nurnberg, Univ Klin, Med Klin 5, Nurnberg, Germany

[8] Univ Klinikum Erlangen, Med Klin 5, Erlangen, Germany

[9] Klinikum Chemnitz, Klin Innere Med 3, Chemnitz, Germany

[10] Univ Klinikum Wurzburg, Med Klin & Poliklin 2, Wurzburg, Germany

[11] Univ Klinikum RWTH Aachen, Med Klin 4, Aachen, Germany

[12] Univ Klinikum Jena, Klin Innere Med 2, Jena, Germany

[13] Univ Klinikum Marburg, Klin Innere Med, Schwerpunkt Hamatol Onkol & Immunol, Marburg, Germany

[14] Univ Klinikum Schleswig Holstein, Klin Innere Med 2, Kiel, Germany

[15] Robert Bosch Krankenhaus Stuttgart, Abt Hamatol Onkol & Palliat Med, Stuttgart, Germany

[16] Gemeinschaftsklinikum Mittelrhein, Palliat Med, Hamatol Onkol, Innere Med, Koblenz, Germany

[17] Rems Murr Klinikum, Klin Hamatol Onkol & Palliat Med, Winnenden, Germany

[18] Helios Dr Schmidt Kliniken Wiesbaden, Innere Med 3, Wiesbaden, Germany

[19] Klinikum Bayreuth, Klin Onkol & Hamatol, Bayreuth, Germany

[20] Agaples Diakonieklinikum, Klin Hamatol Onkol & Stammzelltransplantat, Rotenburg, Germany

[21] Klinikum Bielefeld, Klin Hamatol Onkol & Palliat Med, Bielefeld, Germany

[22] St Bernward Krankenhaus, Med Klin 2, Hildesheim, Germany

[23] DIAKO Bremen, Hamatol & Onkol, Med Klin 2, Bremen, Germany

[24] Univ Klinikum Halle Saale, Univ Klin & Poliklin Innere Med 4, Halle, Saale, Germany

[25] DKMS Clin Trials Unit, Dresden, Germany

[26] Univ Klinikum Leipzig, Klin & Poliklin Hamatol Zelltherapie & Hamostaseo, Leipzig, Germany

来源：

BLOOD | 2020年 / 136卷 / 07期

关键词：

CHEMOTHERAPY; INITIATION; ADULTS; OLDER;

D O I：

10.1182/blood.2019004583

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

In fit patients with newly diagnosed acute myeloid leukemia (AML), immediate treatment start is recommended due to the poor prognosis of untreated acute leukemia. We explored the relationship between time from diagnosis to treatment start (TDT) and prognosis in a large real-world data set from the German Study Alliance Leukemia-Acute Myeloid Leukemia (SAL-AML) registry. All registered non-acute promyelocytic leukemia patients with intensive induction treatment and a minimum 12 months of follow-up were selected (n = 2263). We analyzed influence of TDT on remission, early death, and overall survival (OS) in univariable analyses for each day of treatment delay, in groups of 0 to 5, 6 to 10, 11 to 15, and >15 days of TDT, adjusted for influence of established prognostic variables on outcomes. Median TDT was 3 days (interquartile range, 2-7). Unadjusted 2-year OS rates, stratified by TDT of 0 to 5, 6 to 10, 11 to 15, and >15 days, were 51%, 48%, 44%, and 50% (P = .211). In multivariable Cox regression analysis accounting for established prognostic variables, the TDT hazard ratio as a continuous variable was 1.00 (P = .617). In OS analyses, separately stratified for age <= 60 and >60 years and for high vs lower initial white blood cell count, no significant differences between TDT groups were observed. Our study suggests that TDT is not related to survival. As stratification in intensive first-line AML treatment evolves, TDT data suggest that it may be a feasible approach to wait for genetic and other laboratory test results so that clinically stable patients are assigned the best available treatment option.

引用

页码：823 / 830

页数：8

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