Acute Myeloid Leukemia - Longer time from diagnosis to initiation of hypomethylating agents plus venetoclax does not worsen survival: COMMAND results

Q: What question did the study address about acute myeloid leukemia treatment timing?

The study assessed whether a longer time from diagnosis to treatment initiation (TDT) affects overall survival in newly diagnosed AML patients treated with hypomethylating agents plus venetoclax.

Q: How many patients were included and what was the median age?

The cohort included 488 patients with a median age of 76 years.

Q: What did the study find about TDT categories and overall survival?

Patients with TDT <14 days had worse overall survival than those with TDT ≥14 days. In multivariable analysis, TDT ≥14 days remained associated with improved overall survival after adjusting for multiple clinical and molecular factors.

Sep 29, 2026

Uploaded by Miles

A US, multi-center retrospective cohort study evaluated whether longer time from diagnosis to treatment start (TDT) affects overall survival in patients with newly diagnosed acute myeloid leukemia receiving hypomethylating agents plus venetoclax. Among 488 patients (median age 76), median TDT was 9 days. Patients with TDT under 14 days showed worse overall survival than those with TDT 14 days or more. Multivariable analysis adjusted for clinical factors and molecular mutations supported the association. Results suggest stable patients may wait for appraisal of AML biology and medical optimization before induction therapy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Oncologic emergency framing and treatment timing

Impact of molecular testing turnaround on TDT

Prior studies evaluating TDT and outcomes

ARTICLE-Acute Myeloid Leukemia Longer time from diagnosis to initiation of hypomethylating agents plus venetoclax for acute myeloid leukemia does not worsen survival: results from the Consortium on Myeloid Malignancies and Neoplastic Diseases (COMMAND) Samuel J. Yates,1 Julian J. Weiss,2 Abigail Sneider,3 Emily Geramita,4 Guru Subramanian Guru Murthy,5 Talha Badar,6 Annie Im,4 Chenyu Lin,7 Wei Cheng,8 Yasmin Abaza,9 Alok Swaroop,9 Eric S. Winer,10 Mark R. Litzow,11 Ehab L. Atallah,5 Anand Ashwin Patel1\# and Rory M. Shallis12\# 1 Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL; 2 Duke University Medical Center, Durham, NC; 3 University of Chicago, Pritzker School of Medicine, Chicago, IL; 4 UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA; 5 Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI; 6 Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL; 7 Duke University Cancer Institute, Durham, NC; 8 Department of Biostatistics, Yale School of Public Health, New Haven, CT; 9 Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; 10 Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; 11 Mayo Clinic, Rochester, MN and 12Section of Medical Oncology and Hematology, Department of Internal Medicine, Yale School of Medicine-Yale Cancer Center, New Haven, CT, USA \#AAP and RMS contributed equally as senior authors. Abstract Correspondence: R. M. Shallis [rory.shallis@yale.edu](rory.shallis@yale.edu) Received: April 20, 2025. Accepted: July 14, 2025. Early view: July 24, 2025. [https://doi.org/10.3324/haematol.2025.288085](https://doi.org/10.3324/haematol.2025.288085) ©2026 Ferrata Storti Foundation Published under a CC BY-NC license A diagnosis of acute myeloid leukemia (AML) has been considered an oncologic emergency. However, the prevailing wisdom to quickly administer AML-directed therapy is often in conflict with the time needed to complete the evaluation of actionable AML disease biology. Previous studies in intensively treated patients reported that time from date of diagnosis to treatment start date (TDT) did not impact survival outcomes. We conducted a US-based, multi-center, retrospective cohort study assessing the impact of TDT on overall survival (OS) in patients with newly diagnosed AML treated with hypomethylating agents (HMA) + venetoclax at eight participating academic centers. Four hundred and eighty-eight patients were included with a median age of 76 years. Patients had favorable (47.6%), intermediate (22.8%), and adverse (29.6%) risk disease by the 2024 European LeukemiaNet (ELN) 2024 less-intensive risk classification. Median TDT for the cohort was 9 days (interquartile range [IQR], 5-17) . Those with TDT <14 days (median OS, 8.2 months; 95% confidence interval [CI]: 6.8-9.9) versus ≥14 days (median OS, 11.3 months; 95% CI: 9.5-15.4) had worse OS (P=0.007) . TDT ≥14 days was associated with improved OS in multivariable analysis (hazard ratio =0.73, 95% CI: 0.54-0.97; P=0.033) adjusting for age, performance status, use of cytoreductive therapy, white blood cell count at presentation, ELN 2024 less-intensive risk classification, and presence of FLT3-ITD, TP53, and IDH1/2 mutations. These results suggest that stable patients with newly diagnosed AML eventually treated with HMA + venetoclax may await appraisal of disease biology and medical optimization before initiating induction therapy. Introduction Acute myeloid leukemia (AML) is an aggressive hematologic malignancy that has been considered by many oncologiststo be an oncologic emergency often leading to immediate hospital admission for expeditious evaluation and treatment. However, the prevailing wisdom to quickly administer AML-directed therapy is commonly in conflict with the time needed to complete the evaluation of actionable AML disease biology. The past two decades have s

FAQs

What question did the study address about acute myeloid leukemia treatment timing?

The study assessed whether a longer time from diagnosis to treatment initiation (TDT) affects overall survival in newly diagnosed AML patients treated with hypomethylating agents plus venetoclax.

How many patients were included and what was the median age?

The cohort included 488 patients with a median age of 76 years.

What did the study find about TDT categories and overall survival?

Patients with TDT <14 days had worse overall survival than those with TDT ≥14 days. In multivariable analysis, TDT ≥14 days remained associated with improved overall survival after adjusting for multiple clinical and molecular factors.

Sep 29, 2026

Uploaded by Miles