ASH 2024 | Impact of time from diagnosis to treatment in patients with AML treated with HMA plus venetoclax

This was an oral presentation that was delivered by one of the University of Chicago’s outstanding fellows, Dr Samuel Yates. And as you stated, this was an analysis of patients that were included in what we call the COMMAND database, which is a collection of anywhere from eight to ten academic medical centers. I believe eight contributed to this specific analysis. We looked at well over 400 patients and tried to answer the question, does time from diagnosis to treatment impact outcomes. The prevailing wisdom in the management of AML has been for quite some time to administer therapy very, very early. Is AML an oncologic emergency? At most, I’d say academic medical centers, this is not felt to be the case. There are some patients that do present with some clinical complications which necessitate earlier intervention, if not emergent intervention, but we do think patients are best served if it’s in the cards for them to have this time to wait in the absence of these complications to wait for what we’ll call the disease biology, looking for actionable molecular lesions and mutations, things like TP53, IDH1/2, NPM1, and other FISH-related aberrations which can inform the optimal induction strategy, which could be intensive or less intensive. The intensive literature is quite firm; there have been a number of studies which have looked at intensive treatment and found that there’s no detriment to waiting a bit longer to get this information, but for looking at less intensively treated patients, scant literature. So we tried to answer this question, and perhaps no surprise, there was no major impact. Median time from diagnosis to treatment was nine days in our fairly large cohort. We did look at some subgroup analyses and ultimately found that although some molecular lesions did associate with overall survival, through comparative analyses, we found that there was really no detriment to waiting this time. There was a range. We did a couple of subgroup analyses looking at it, would be less than 10 days, 14 to 15, even beyond 20 days, which was a minority of the population. But long story short, we did find that it appears that patients are best served, in the absence of these complications, with waiting for this disease biology to really be announced to inform, in this case, what were azacitidine venetoclax-treated patients.

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