Reconsidering time from diagnosis to treatment in acute myeloid leukemia: from therapeutic urgency to biologically informed timing.

INTRODUCTION

Acute myeloid leukemia (AML) has traditionally been considered a medical emergency requiring immediate cytotoxic therapy, a paradigm rooted in the pre-molecular era and high early mortality of untreated disease. However, modern AML management relies on cytogenetic, molecular, and next-generation sequencing (NGS) profiling to guide prognosis, transplant decisions, and targeted therapies, making time from diagnosis to treatment (TDT) a clinically relevant variable.

AREAS COVERED: A focused literature review (PubMed/MEDLINE, Embase, Web of Science) shows that short, biologically driven delays to complete molecular diagnostics do not adversely affect survival, including in patients receiving venetoclax-based regimens. Conversely, prolonged system-related delays remain associated with worse outcomes. The impact of TDT is heterogeneous across molecular subgroups, with emerging data suggesting differential sensitivity in IDH1/2- and TP53-mutated AML. In the NGS era, the diagnostic-to-treatment interval should be viewed as an active, biologically informed phase rather than a passive delay.

EXPERT OPINION: TDT should be considered a biology-adapted decision rather than a measure of urgency: brief, purposeful delays to refine genomic profiling may optimize treatment selection without compromising outcomes, whereas system-driven delays remain harmful and inequitable.