-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

5058 Impact of Ultra Rapid Molecular Profiling on Treatment Delays and Healthcare Utilization of Patients Hospitalized for Acute Leukemia

Program: Oral and Poster Abstracts
Session: 903. Health Services and Quality Improvement: Myeloid Malignancies: Poster III
Hematology Disease Topics & Pathways:
Lymphoid Leukemias, ALL, Acute Myeloid Malignancies, AML, Clinical Practice (Health Services and Quality), Assays, APL, Diseases, Lymphoid Malignancies, Myeloid Malignancies, Emerging technologies, Technology and Procedures, Profiling, Molecular testing
Monday, December 9, 2024, 6:00 PM-8:00 PM

Tejaswini Dhawale, MD1,2, Valentina Nardi, MD3,4*, Charlotte Wang, MD, PhD2,5*, Adam Bard5*, Natalia Essigmann6*, Daniel Leonard, MD, PhD5*, Timothy Aaron Graubert, MD2,7 and Amir T. Fathi, MD2,8

1MGH, West Newton, MA
2Harvard Medical School, Boston, MA
3Pathology Division, Harvard Medical School, Boston, MA
4Department of Pathology, Massachusetts General Hospital, Boston, MA
5Massachusetts General Hospital, Boston, MA
6Newton Wellesley Hospital and Clinics, Newton, MA
7Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
8Center for Leukemia, Massachusetts General Hospital Cancer Center, Boston, MA

Background

Molecular testing is fundamental to treatment decisions in patients with acute leukemia. The impact of rapid molecular profiling on the timing of treatment initiation and healthcare utilization in patients hospitalized for suspected acute leukemia has not been described.

Methods

We conducted a retrospective chart review of patients hospitalized and treated for suspected acute leukemia at Massachusetts General Hospital between September 2023 and April 2024. We conducted a detailed workflow analysis comparing the time to obtaining molecular profiling results from admission [“time to results” or TTR] between routine (legacy) methods (i.e., RT-PCT, karyotype, FISH, targeted DNA and RNA sequencing) and an ultra-rapid genomic profiling test (Thermo Fisher Genexus Oncomine Myeloid Panel, or “Genexus”) which was run in parallel. We used linear regression models to evaluate the impact of TTR on time to treatment initiation from admission [TTTI] and hospital length of stay [LOS].

Results

Of the 111 patients who had ultra-rapid genomic profiling conducted during the study period, 57 (51.4%) were adult patients who were hospitalized for diagnostic workup and treatment of suspected acute leukemia. The most common leukemia subtypes were acute myeloid leukemia (n=39/57, 68.4%), B-lymphoblastic leukemia (n=9/57, 15.8%), and acute promyelocytic leukemia (n=4/57, 7.0%). The mean TTTI was 5.2 days (range 1-17) and mean LOS was 30.9 days (range 3-86). Genexus had a mean TTR of 3.1 days (range 1-8), whereas legacy methods had a mean TTR of 5.4 days (range 3-10). Longer TTR was associated with longer TTTI (b=0.95; SE=0.20; P=<0.001) and longer LOS (b=4.08; SE=1.30; P=<0.003).

Conclusions

Ultra-rapid molecular profiling reduces the time to obtaining actionable genetic sequencing results for patients hospitalized for suspected acute leukemia by 2 days compared to legacy methods. Delays in obtaining molecular profiling of these patients is associated with treatment initiation delays and longer hospital length of stay, underscoring the importance of expanded access to ultra-rapid molecular profiling for acute leukemia. Further work is needed to elucidate the full economic impact of ultra-rapid molecular profiling on overall healthcare utilization.

Disclosures: Fathi: Pfizer: Consultancy; Orum: Consultancy; Servier: Consultancy, Research Funding; Bristol Myers Squibb: Consultancy, Research Funding; PureTech: Consultancy; Rigel: Consultancy; Takeda: Consultancy; Daiichi Sankyo: Consultancy; Forma: Consultancy; Menarini Group: Consultancy; Remix: Consultancy; Ispen: Consultancy; Gilead: Consultancy; Genentech: Honoraria; AstraZeneca: Honoraria; EnClear: Consultancy; Ipsen: Consultancy; Mablytics: Consultancy; ImmunoGen: Consultancy; Abbvie: Consultancy, Research Funding; Astellas: Consultancy; Amgen: Consultancy; Autolus: Consultancy; BMS/Celgene: Consultancy; Novartis: Consultancy; Agios: Ended employment in the past 24 months; MorphoSys: Consultancy; Kite: Consultancy; Foghorn, Blueprint Medicines, Kura, Trillium: Honoraria; AbbVie, BMS/Celgene, and Agios/Servier: Research Funding.

*signifies non-member of ASH