Optimal timeframes & summary
Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Acute Myeloid Leukaemia Working Group.
Timeframes for care
|
Step in pathway |
Care point |
Timeframe |
|
Presentation, initial investigations and referral |
Signs and symptoms |
Presenting symptoms should be promptly and clinically triaged with a health professional |
|
Initial investigations initiated by GP |
The GP should begin investigations immediately if AML is suspected Laboratory results should be actively followed up and progressed on the same day |
|
|
Referral for emergency assessment/ Initial referral |
Patients with sepsis, bleeding or severe symptoms should be regarded as a medical emergency and be referred immediately to an appropriate emergency facility without necessarily waiting for results of laboratory tests (same day) Patients with a laboratory diagnosis of possible AML should be referred for an urgent assessment by a haematologist at an appropriate facility within 24 hours (unless advised otherwise by a haematologist) |
|
|
Diagnosis, staging and treatment planning |
Diagnosis and staging |
Morphological assessment to identify APL should be conducted immediately and the result conveyed to the treating physician as soon as possible For all patients with AML, other results necessary for immediate management decisions should be available within 72 hours of the patient presenting |
|
Multidisciplinary meeting and treatment planning |
Immediate treatment is often required before a full MDM ratifies the management plan details. Multidisciplinary input is likely to be required at several points after the first treatment begins |
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|
Treatment |
Systemic therapy |
Induction therapy should start promptly once a diagnosis is made and a treatment plan for intensive chemotherapy is confirmed Consolidation therapy should start within 6 weeks of induction chemotherapy beginning |
|
Allogenic stem cell transplant |
Donor searches should begin for all anticipated allogeneic stem cell transplant (allo-SCT) canditates in first remission (CR1) patients as soon as their risk status is known |
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|
Radiation therapy |
Radiation therapy may be used for symptom control in palliation and occasionally for treatment |
Seven steps of the optimal care pathway
Step 1: Prevention and early detection
Step 2: Presentation, initial investigations and referral
Step 3: Diagnosis, staging and treatment planning
Step 4: Treatment
Step 5: Care after initial treatment and recovery
Step 6: Managing relapsed or refractory disease
Step 7: End-of-life care
This pathway covers acute myeloid leukaemia (AML) in adults, including acute promyelocytic leukaemia (APL). AML is the most common form of acute leukaemia in adults (NCCN 2019). The yearly incidence rate of AML in Australian adults is 3.9 cases per 100,000, with a five-year survival rate of 28 per cent (AIHW 2019).
