Patient-Centered Genomic Diagnostic Testing for AML: A Quality Improvement Project.

Area of Science:

• Hematology
• Genomics
• Clinical Diagnostics

Background:

• Acute myeloid leukemia (AML) classification and treatment are increasingly guided by specific genetic subtypes.
• Accurate and timely cytogenetic and molecular testing is crucial for personalized AML therapy.
• Current diagnostic processes present challenges in test ordering and turnaround times (TATs).

Purpose of the Study:

• To optimize the process for ordering genomic diagnostic tests in AML.
• To reduce the turnaround time (TAT) for essential genomic tests in AML patients.
• To enhance the efficiency of diagnostic workflows for newly diagnosed AML (ND-AML).

Main Methods:

• A multidisciplinary working group developed a reflex testing algorithm for ND-AML, triggered by flow cytometry.
• Key tests included next-generation sequencing (NGS) myeloid panel, karyotype, and specific PCR assays (FLT3, NPM1, CBFB::MYH11, RUNX1::RUNX1T1).
• Three Plan-Do-Study-Act (PDSA) cycles were implemented, focusing on education, algorithm implementation, and NGS workflow automation.

Main Results:

• Test ordering compliance improved to over 90% after PDSA 2.
• TAT for NGS was reduced by 63.3% to 11.4 days after PDSA 3, meeting the 14-day target.
• Target TAT of ≤5 days was achieved for FLT3 and NPM1 PCR tests.

Conclusions:

• A collaborative, multidisciplinary approach was key to developing an effective reflex testing algorithm for AML.
• The implemented algorithm significantly improved test ordering practices and reduced diagnostic TATs.
• Streamlined genomic testing supports timely and personalized treatment decisions for AML patients.