OBJECTIVES : In the treatment of acute myeloid leukemia (AML), molecularly targeted therapy guided by timely mutational testing can lead to improved patient outcomes. This study assessed how IDH1/2 mutational testing and results are accessed, used and adopted, and factors associated with treatment selection for patients with relapsed or refractory (RR) AML.

METHODS : US hematologists/oncologists from the Cardinal Health Oncology Provider Extended Network (OPEN) who had treated patients with AML completed a 23-item questionnaire in February/March 2020 assessing perceptions and experiences involving mutational testing and AML treatment selection. Responses were summarized using descriptive statistics.

RESULTS : Nearly all physicians (95%) responded that they perform IDH1/2 mutational testing at AML diagnosis, 75% at relapse/progression, and 15% at completion of induction/remission. Approximately one-third (35%) utilized in-house pathology services, while the rest sent the sample off-site. Most (75%) received IDH1/2 mutational test results within 10 days, and the remainder (25%) within 11–20 days. The results were most often (75%) and sometimes (20%) used to select the AML treatment regimen; 5% reported results took too long and did not impact treatment selection. The majority of respondents (55%) were willing to wait (median=10 days) for mutational status results before starting treatment; 20% would not wait but would change treatment based on IDH mutation status; 20% would not wait and would not change treatment based on IDH mutation status. The majority (85%) preferred enasidenib as first therapy in patients with IDH2-mutated RR AML, while 15% preferred high-dose cytarabine (10%) or low-dose cytarabine (5%).

CONCLUSIONS : The results demonstrate that for those AML treatments targeting specific mutations, mutational testing and its appropriate timing does guide physicians’ treatment selection. Physicians recognize the value of testing, and when results are timely, the results are used in determining appropriate treatment for patients with AML.