Consortium aims to improve outcomes for adolescents, young adults with lymphoma
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The Lymphoma Research Foundation formed a multidisciplinary consortium dedicated to advancing and harmonizing treatment for adolescents and young adults with lymphoma.
The consortium aims to improve care for patients aged 15 to 39 years, from diagnosis through survivorship.
The consortium will be led by Lymphoma Research Foundation (LRF) scientific advisory board members Andrew M. Evens, DO, MBA, MSc, of Rutgers Cancer Institute of New Jersey and RWJBarnabas Health, and Kara M. Kelly, MD, of Roswell Park Comprehensive Cancer Center and University of Buffalo Jacobs School of Medicine and Biomedical Sciences.
“Patients presenting within this age group have historically not experienced the same gains in survival as younger patients and older adults,” Kelly told Healio. “There are also many developmental concerns that affect this population as they emerge into independence and start their lives, and these can really impact their cancer journey.”
Healio spoke with Kelly and Evens about the consortium’s goals for adolescent and young adult (AYA) cancer care, as well as how hematologists and oncologists can help advance these efforts.
Healio: What motivated you to form this consortium?
Evens: Over the last 10 to 15 years, the incidence of AYA lymphoma has plateaued. Yet there is a disparate, if not lagging, survival advantage for adolescents and young adults compared with children or older adults with lymphoma, and we don’t know why. Is this driven by social factors? Is it about access to care? Is there something unique in the disease biology of these patients?
To further complicate matters, there has been a lack of harmonization historically between pediatrics and adult oncology in recommendations for AYA lymphoma. An 18-year-old patient may present to a pediatrician and an adult oncologist at an academic medical center for the same disease and get different treatment recommendations. A key component of our effort is to harmonize across the adult/pediatric expert aisles for treatment and survivorship recommendations. This is important through the patient lens of having more synthesized recommendations, and in terms of advancing the field and discovering cures at a faster rate.
Healio: What will your efforts entail?
Kelly: The LRF has been instrumental in bringing together medical and pediatric oncologists with an interest in AYA lymphoma. We had three scientific meetings that served as great opportunities to share treatment approaches and identify priorities. We recognized that having a formal consortium would help us keep these efforts going. We wanted to bring everyone together to develop treatment recommendations, and then expand into understanding disease biology and survivorship issues.
We also want to bring in important stakeholders from across the spectrum of AYA lymphoma. I am a pediatric oncologist. One area of frustration for me is that, for many early-phase clinical trials of new drugs, the age of entry is 18 years. So, my adolescent patients have to wait to access some of these new therapies, despite the fact that their disease is exactly the same.
Much of our work will involve reaching out to pharmaceutical companies, the FDA and the NCI, trying to engage all stakeholders so we can work through these challenges.
Evens: It takes a village for many things in life, and this is one situation where it’s not just pediatric and adult oncologists in a room discussing and strategizing. It’s the government, including the NCI’s Cancer Therapy Evaluation Program and the FDA, as well as the pharmaceutical industry and other companies. It’s not just primary clinicians, either. It’s laboratory translational scientists, epidemiologic experts, social scientists and — critically — patient advocates. LRF is the ultimate convener — it brings people together to identify solutions to complex problems.
Healio: What do you hope will be the long-term impact of the consortium?
Kelly: We are on the cusp of being able to harmonize treatment approaches in a few disease areas, such as Hodgkin lymphoma. The pediatric approach has historically been quite different than the adult approach. We want to facilitate developing clinical trials together that impact the standard of care. The SWOG S1826 study presented during the plenary session of last year’s ASCO Annual Meeting is a perfect example. It enrolled adolescent patients and it’s really going to change how we treat patients with advanced-stage Hodgkin lymphoma. We want to extend that so there is a standard treatment approach. We also want to address survivorship recommendations — that’s a substantial void, as there’s great variation in recommendations for when screening tests for late toxicities are performed. We’ll get there by promoting research and getting more people interested in performing clinical studies that will help move this field forward.
Evens: Although we have a lot of work to do, there already have been some great outputs. It’s unique — not just nationally but globally — to see pediatrics and adult oncology truly at the table working together.
The SWOG 1826 study involved all of the adult cooperative groups in the NCI, as well as the Children’s Oncology Group (COG), not just in the enrollment of patients but sitting together and collaborating to find the best solution for all patients.
There is other research ongoing. We are now conducting an early-stage Hodgkin lymphoma study, AHOD2131. COG is taking the lead on this study, which is co-led by Kara and medical oncologist Boyu Hu, MD, of Huntsman Cancer Institute at University of Utah. All of the adult NCI cooperative groups are participating, and it is a national high-priority study.
Healio: What can hematologists and oncologists do to support LRF’s efforts through this consortium?
Kelly: This consortium will have open membership for clinicians, researchers and others interested in the field. We’re just getting it off the ground, but soon there will be a more public call for members. We are working on various programs to further this effort.
Evens: We want this to be an open tent, and we want to solicit all the ideas, interest and solutions we can in order to advance this field. From our last workshop, we compiled a timely series of review articles published in eJHaem that outlined the need and recommendations for next steps for AYA lymphomas. That’s another great way for everyone to see in detail the areas we’re focusing on and the path we have started to chart.
References:
- ClinicalTrials.gov. A study to compare standard therapy to treat Hodgkin lymphoma to the use of two drugs, brentuximab vedotin and nivolumab. Available at: https://classic.clinicaltrials.gov/ct2/show/NCT05675410. Accessed on Feb. 29, 2024.
- Evens AM, et al. EJHaem. 2023;doi:10.1002/jha2.793.
- Kahn JM, et al. Blood Adv. 2017;doi:10.1182/bloodadvances.2017008748.
- Kelly KM, et al. Ann Lymphoma. 2019;doi:10.21037/aol-2020-02.
- Lymphoma Research Foundation. Adolescent and young adult (AYA) cancer experts unite to form first-of-its-kind consortium (press release). Available at: https://www.prweb.com/releases/adolescent-and-young-adult-aya-cancer-experts-unite-to-form-first-of-its-kind-consortium-302047782.html. Posted Jan. 30, 2024. Accessed Feb. 26, 2024.
For more information:
Andrew M. Evens DO, MBA, MSc, can be reached at Rutgers Cancer Institute, 195 Little Albany St., New Brunswick, NJ 08901; email: andrew.evens@rutgers.edu.
Kara M. Kelly, MD, can be reached at Roswell Park Comprehensive Cancer Center, 665 Elm St., Buffalo, NY 14203; email: kara.kelly@roswellpark.org.
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