Dr. Mims on Waiting for Molecular Tests Before Starting Therapy in AML

Alice S. Mims, MD, medical oncologist, Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center—James, discusses her recommendations regarding holding therapy until molecular test results are received for symptomatic patients with acute myeloid leukemia (AML).

Whether a symptomatic patient waits for their molecular testing results depends on their molecular profile, explains Mims. Patients with proliferative disease who have high white blood counts, require leukapheresis, or have symptoms of disseminated intravascular coagulation may want to start treatment because it is not safe to wait, says Mims.

For most patients, it takes at least 1 week to receive molecular profiling results. Midostaurin (Rydapt), which is approved for patients with newly diagnosed, FLT3-mutatied AML, is not started until day 8 after 7+3 therapy starts. Therefore, it is appropriate to wait to start targeted therapy. For other targeted therapeutics, when a patient should start therapy depends on the setting, concludes Mims.