Download Full Text (964 KB)
Henry Ford Hospital
Introduction: Acute myeloid leukemia (AML) is one of the hematologic emergencies that require prompt treatment. Advanced changes in the molecular pathogenesis has been emerging with major impact on prognosis and treatment. FLT3 mutation is associated poor prognosis and early relapse in AML. Midostaurin is a multi-kinase inhibitor, when combined with induction 7+3 chemotherapy, improves the response rate and disease-free survival. Purpose: To evaluate our institution efficiency obtaining the appropriate molecular studies in AML cases at the time of diagnosis. Time is very sensitive in the management of acute myeloid leukemia. Induction chemotherapy should be administered once morphologic diagnosis is made. It requires high collaboration between the hematologist, pathologist and laboratory staff. Once molecular studies are available, the need for targeted therapy will be determined. next generation sequencing (NGS) is fast and comprehensive method in molecular analysis Methods: The electronic medical records were reviewed for all AML cases diagnosed between January 2016 and December 2018. Quality measures were defined by: Average duration between bone marrow biopsy and the morphology results, average duration between bone marrow biopsy and date of molecular order, the type of molecular study ordered, average duration between molecular order and available results. We investigated the delay in administering midostaurin in cases with FLT3 mutation. Results: Between January 2016 and December 2018, there was 86 AML cases diagnosed and treated in our hospital. All patients were admitted to the hospital. The average duration between bone marrow biopsy and morphology results is 3 days. Molecular studies were obtained in 65 cases (75.5%). In 2018, molecular studies were ordered in 91% of new AML cases. Molecular studies were ordered as: (NGS)-54 gene in 18 cases; the rest were ordered as custom panel. The average duration between the molecular order and result dates is 9.3 days. The Average duration between induction date and molecular results is 8.8 days. FLT 3 mutation analysis was included in 51 cases (59%) and was detected in 18 cases (21%). Midostaurin is administered in 13 cases. The average delay in administering midostaurin is 2.75 days. Discussion: Our institution experience has improved in the past 3 years increasing the rate of ordering molecular studies. However, there is an average 2.7-day delay in administering targeted therapy due to the delay ordering and getting the results in appropriate time manner. We suggested the following changes: 1. Standardize the order by obtaining NGS-54 gene panel on all Leukemia cases. 2. Discuss all new leukemia cases in multidisciplinary conference to ensure better communication. 3. Address the efficacy of these measures in new AML cases diagnosed in 2019.
Khaddour, Leila; Donthireddy, Vijayalakshmi; and Dabak, Vrushali, "Acute Myeloid Leukemia: The Race to Diagnosis and Treatment!" (2019). Quality Improvement. 9.