Impact of diagnosis-to-treatment interval on the outcome of patients with acute myeloid leukemia.

Acute myeloid leukemia (AML) is considered an oncologic emergency, yet the optimal timing for treatment initiation remains uncertain. We conducted a multi-institutional retrospective study of 698 adults with newly diagnosed AML presenting to four academic centers across the United States. Diagnosis-to-treatment intervals (DTI) were categorized as < 5 days, 5-10 days, and > 10 days. Outcomes were analyzed using multivariable models adjusting for age, treatment intensity, ELN 2017 risk classification, and white blood cell count. Among younger patients, DTI was not associated with differences in survival outcomes. In contrast, older patients demonstrated improved survival with delayed treatment (DTI > 10 days), particularly those with lower white blood cell counts. No adverse effects from treatment delay were observed in younger cohorts. This retrospective study showed that prolonged DTI is associated with improved survival in older adults with newly diagnosed AML, challenging the traditional assumption that immediate therapy universally improves outcomes. These findings underscore the importance of individualized treatment timing in the era of precision oncology.