Remission to Transplantation Time in Acute Myeloid Leukemia

Introduction Timely access to transplantation for patients with acute myeloid leukemia avoids bridging chemotherapy and associated toxicity, avoids early relapse, and minimizes resource utilization. Evidence indicates that consolidation chemotherapy is not beneficial and that transplantation should follow as soon as possible after attainment of remission. Methods We performed a retrospective single center review of all AML patients (n = 46) receiving transplantation between January 2013 and September 2015 to determine the time interval of remission to transplantation (Remission to Transplant Interval, RTI). Patient and process characteristics were identified and described using descriptive statistics. Results Patient characteristics are outlined in table 1. Median time to transplantation was 122 days (IQR 69-168). Patients received a median of 2 (range 0-4) cycles of consolidation chemotherapy while awaiting transplant. There were thirty-two unplanned admissions, including four admissions to the intensive care unit. There was marked variability in the RTI (Figure 1). Table two shows RTI was significantly longer for those transplanted in first complete remission than in those in second complete remission (median 149 vs 75 days, p = 0.002). The median number of days from remission to final donor identification was 36 (IQR -3 to 93) days and the median time from donor identification to Day 0 of transplantation was 81.5 days (IQR 59-108). Conclusion We demonstrate that a sizeable proportion of the cohort waited months for their transplant and there are opportunities for system improvements. The RTI represents an important metric for transplant program performance with potential impacts on patient outcomes that should be tracked.