Abstract
The effect of time from diagnosis to treatment (TDT) on overall survival of patients with acute myeloid leukemia (AML) remains obscure. Furthermore, whether chemotherapy delay impacts overall survival (OS) of patients with a special molecular subtype has not been investigated. Here, we enrolled 364 cases of AML to assess the effect of TDT on OS by fractional polynomial regression in the context of clinical parameters and genes of FLT3ITD, NPM1, CEBPA, DNMT3a, and IDH1/2 mutations. Results of the current study show IDH1/2 mutations are associated with older age, M0 morphology, an intermediate cytogenetic risk group, and NPM1 mutations. TDT associates with OS for AML patients in a nonlinear pattern with a J shape. Moreover, adverse effect of delayed treatment on OS was observed in patients with IDH1/2 mutations, but not in those with IDH1/2 wildtype. Therefore, initiating chemotherapy as soon as possible after diagnosis might be a potential strategy to improve OS in AML patients with IDH1/2 mutations.
Highlights
Acute myeloid leukemia (AML) is a heterogeneous group of hematologic malignancies characterized by the rapid growth of leukemia cells requiring immediate therapeutic intervention
As IDH1 and IDH2 mutations were mutually exclusive and appeared to have same biologic functions, we examined the clinical features of IDH1 and IDH2 mutations as a collective group
We found the frequency of IDH1/2 mutations of AML patients was 23%, which is similar to most previous reports[13, 14]
Summary
Acute myeloid leukemia (AML) is a heterogeneous group of hematologic malignancies characterized by the rapid growth of leukemia cells requiring immediate therapeutic intervention. The prognostic significance of TDT in AML patients remains controversial It is worth noting several gene mutations such as IDH1/2 mutations are closely correlated to older age[4], and age was regarded as an interactive factor for the prognosis of TDT in a previous report[1]. We found that delayed TDT was an adverse predictor for overall survival occurring in patients with IDH1/2 mutations but not in those with IDH1/2 wild type This result introduces a new way for clinicians to improve outcomes by the tailored therapy as soon as diagnosis occurs for IDH1/2 mutant cases
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