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Impact of chemotherapy delay on short- and long-term survival in younger and older AML patients: a Danish population-based cohort study

Leukemia volume 28, pages 1926–1929 (2014)Cite this article

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In recent decades, new strategies and molecularly targeted approaches have been developed to improve treatment in acute myeloid leukemia (AML) patients. To direct therapy, results of conventional cytogenetic and molecular mutation analysis are required.1 Results can be ready in 72 h, but are generally not available until after 5 days. A relevant question is whether the outcome is affected if intensive chemotherapy awaits results. Only two studies exist on this topic. In an observational US study of 1317 AML patients, delaying treatment beyond 5 days resulted in inferior complete remission (CR) rates and overall survival in younger patients, but not in patients ⩾60 years.2 As a consequence, LeukemiaNet recommends treatment initiation before day 5 in younger patients.3 In a French single-center study of 599 patients, no association was found of treatment delays above 5 days compared with patients with a time to treatment initiation (TTT) below 5 days in terms of early death, CR rates and long-term survival.4 The two studies have important limitations, and the results may not be generalizable to other patients.5

We designed a national population-based cohort study to investigate the effect of TTT on CR rates and overall survival (30-day and 31-day–3-yearsurvival) in AML patients treated with curative intent in Denmark during 2000–2012. We used the Danish National Acute Leukemia Registry to identify all non-promyelocytic AML patients. The registry covers all AML patients diagnosed in Denmark, and it prospectively collects high-quality demographic, clinical, treatment and outcome data.6 Information on comorbidity was obtained through the Danish National Registry of Patients.7 Information on all-cause mortality was obtained from the Civil Registration System.8

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Acknowledgements

This study was supported by research funding from the Danish Cancer Society, The University of Aarhus (Faculty of Health), the AV Lykfeldt’s Foundation, Gr Brogaard and Wife’s Foundation, F Ejner Willumsen’s Grant, Arvid Nilsson’s Foundation and Fraenkel’s Memorial Foundation to LGSØ. None of the funding sources had a role in the design, conduct, analysis or reporting of the study results.

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Authors and Affiliations

  1. Department of Hematology, Aarhus University Hospital, Aarhus, Denmark

    L S G Østgard, J M Nørgaard & M S Holm

  2. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

    L S G Østgard & M Nørgaard

  3. Department of Hematology, Rigshospitalet, Copenhagen, Denmark

    H Sengeløv & O J Nielsen

  4. Department of Hematology, Herlev Hospital, Herlev, Denmark

    M K Jensen

  5. Department of Hematology, Aalborg University Hospital, Aalborg, Denmark

    M Kallenbach

  6. Department of Hematology, Odense University Hospital, Odense, Denmark

    C W Marcher

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  1. L S G Østgard
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  8. O J Nielsen
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Correspondence to L S G Østgard.

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Østgard, L., Nørgaard, J., Sengeløv, H. et al. Impact of chemotherapy delay on short- and long-term survival in younger and older AML patients: a Danish population-based cohort study. Leukemia 28, 1926–1929 (2014). https://doi.org/10.1038/leu.2014.157

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