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 (Figure 3). 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 Leukaemia in Children, Adolescents and Young Adults (CAYA) Working Group. The pathways covers people diagnosed with acute leukaemia from birth up to the age of 30 years.

Timeframes for care

Step in pathway	Care point	Timeframe
Presentation, initial investigations and referral	Signs and symptoms	Patients with suspicious clinical and/or laboratory findings should be immediately discussed with an appropriate specialist service and clinically triaged with a health professional.
	Initial investigations initiated by GP	The GP/emergency physician should begin investigations immediately and the laboratory results should be processed and followed-up on the same day.
	Referral to specialist	Patients with bleeding, sepsis 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). CAYA with a laboratory diagnosis of acute leukaemia should be referred on the same day to a specialist service and have an urgent assessment within 24 hours (unless advised otherwise by a specialist).
Diagnosis, staging and treatment planning	Diagnosis and staging	Making the diagnosis of CAYA acute leukaemia should begin immediately, including a morphological assessment of blood film by a specialist. Other results necessary for immediate management decisions should be available within 72 hours of the patient presenting.
Diagnosis, staging and treatment planning	Multidisciplinary meeting and treatment planning	Immediate treatment is often required before a full MDM ratifies the plan. Multidisciplinary input is likely after treatment begins.
Treatment	Treatment options	Once the diagnosis is confirmed then systemic therapy should start immediately, with the offer of a clinical trial, if eligible. Note: Consider fertility preservation, if clinically appropriate.

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral step

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing refractory, relapsed, residual or progressive disease

Step 7: End-of-life care

This optimal care pathway is intended as a resource in managing children, adolescents and young adults (CAYA) diagnosed with acute leukaemia from birth up to the age of 30 years.

In 2021, the yearly incidence of acute lymphocytic leukaemia (ALL) in people aged 0–29 years was estimated to be 2.6 cases per 100,000 (or 271 cases).

The yearly incidence of acute myeloid leukaemia (AML) in people aged 0–29 years was estimated to be 0.5 cases per 100,000 (or 52 cases) (AIHW 2021).

This optimal care pathway outlines seven critical steps for CAYA patients diagnosed with acute leukaemia (ALL and AML). The critical steps will require realignment and adjustment to best meet the needs of patients and their families as well as care providers.