Long-term effects of multidisciplinary team recommendations on adult patients with acute myeloid leukemia

Abstract

Optimal post-remission therapy is crucial for long-term survival in patients with acute myeloid leukemia (AML). Multidisciplinary team (MDT) conferences address this challenge by providing comprehensive, patient-centered consultations that support individualized treatment decision-making. We evaluated the effectiveness of MDT conferences in guiding post-remission treatment decisions in adults with de novo AML. We enrolled 653 adult patients with de novo AML who were treated at our center between January 2017 and December 2022. Of the 591 eligible patients (90.5%), 501 (84.8%) attended a scheduled MDT evaluation. Allogeneic hematopoietic cell transplantation (allo-HCT) was recommended for 315 patients (62.9%), of whom 251 (79.7%) subsequently underwent transplantation. Survival analyses showed that MDT attendees had superior 3-year overall survival (68.9% vs. 53.5%, p < 0.0001) and a lower 3-year cumulative incidence of relapse (30.7% vs. 44.9%; p < 0.0001) compared with patients who did not attend MDT conferences. Patients most likely to benefit from allo-HCT following MDT recommendations included those with intermediate- or adverse-risk disease according to the European LeukemiaNet 2017 classification, and those with favorable-risk disease who showed a suboptimal response to induction therapy. The main barriers to allo-HCT were persistent or relapsed disease and patient preference. Overall, MDT conferences effectively identified patients who were most likely to benefit from allo-HCT and were associated with higher transplantation rates within a modern healthcare system.