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Young adults, adolescents with acute lymphoblastic leukemia fare better with pediatric care
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Young adults and adolescents with acute lymphoblastic leukemia who received treatment in pediatric settings survived longer than those treated in adult centers, according to results of an observational, population-based study.
Treatment at an NCI-designated cancer center also appeared associated with improved outcomes.
“Physicians and treatment teams in pediatric and NCI-designated cancer settings may be more experienced in caring for acute lymphocytic leukemia in adolescents and young adults, and this may, in part, explain why we are seeing better outcomes in these centers,” Lori Muffly, MD, medical oncologist at Stanford University, said in a press release.
Muffly and colleagues used the California Cancer Registry to evaluate data from 1,473 patients aged 15 to 39 years who were newly diagnosed with ALL between 2004 and 2014.
Median age at diagnosis was 22 years. Approximately one-third (32.3%) were aged 15 to 18 years, and more than half (56.8%) were aged younger than 25 years. Two-thirds of the patients were male, and nearly two-thirds (63.7%) were of Hispanic race/ethnicity.
Nearly one-third of patients (32%; n = 475) received treatment in a pediatric setting; most of these patients (89%; n = 422) received their front-line therapies at NCI-designated cancer centers.
The remaining 998 patients underwent treatment in adult settings; approximately 40% (n = 406) of this group received treatment at NCI-designated cancer centers.
Treatment in a pediatric setting (HR = 0.53; 95% CI, 0.37-0.76), as well as treatment at NCI- or Children’s Oncology Group-designated centers (HR = 0.8; 95% CI, 0.66-0.96), appeared associated with significantly longer OS.
In addition, treatment in a pediatric setting (HR = 0.51; 95% CI, 0.35-0.74), as well as treatment at an NCI/Children’s Oncology Group center (HR = 0.8; 95% CI, 0.65-0.97), appeared associated with significantly improved leukemia-specific survival.
Researchers observed similar results when they limited their analysis to patients aged 15 to 24 years.
“The results of our study and others demonstrate the importance of [NCI/Children’s Oncology Group] centers to improving adolescent and young adult ALL outcomes and warrant further attention, as only a minority of adolescent and young adults with ALL treated in the adult setting are cared for at these centers,” Muffly and colleagues wrote. “Given the relatively recent adoption of pediatric ALL regimens by medical oncologists, mature population-level data is needed in order to better quantify the evolving impact of pediatric ALL regimens administered by medical oncologists in adult cancer settings.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
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