Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome

Abstract

Background Adolescents and young adults (AYA: 15-39y) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared to children. Impact of care at NCI-designated Comprehensive Cancer Centers (CCC; or Children's Oncology Group sites [COG]) on survival disparities remains unstudied. Methods Using the Los Angeles Cancer registry, we identified 1,870 ALL or AML patients between 1 and 39y at diagnosis. Cox regression analyses assessed risk of mortality; younger age+CCC/COG served as the referent group. Logistic regression was used to determine odds of care at CCC/COG, adjusting for variables above. Results ALL outcome: AYAs at non-CCC/COG experienced inferior survival (15-21y: HR=1.9, p=0.005; 22-29y: HR=2.6, p<0.001; 30-39y: HR=3.0, p<0.001). Outcome at CCC/COG was comparable between children and young AYAs (15-21y: HR=1.3, p=0.3; 22-29y: HR=1.2, p=0.2) but was inferior for 30-39yo (HR=3.4, p<0.001). AML outcome: AYAs at non-CCC/COG experienced inferior outcome (15-21y: HR=1.8, p=0.02; 22-39y: HR=1.4, p=0.06). Outcome at CCC/COG was comparable between children and 15-21yo (HR=1.3, p=0.4) but was inferior for 22-39yo (HR=1.7, p=0.05). Access: 15-21yo were less likely to use CCC/COG than children (p<0.001). In 22-39yo, public/uninsured (ALL: p=0.004; AML<0.001), African-American/Hispanics (ALL: p=0.03), and 30-39yo (ALL: p=0.03) were less likely to use CCC/COG. Conclusions Poor survival in AYAs with ALL and AML is mitigated by care at CCC/COG. Barriers to CCC/COG care include public/uninsured, and African-American/Hispanic race/ethnicity. Impact Care at CCC/COG explains, in part, inferior outcomes in AYAs with ALL and AML. Key sociodemographic factors serve as barriers to care at specialized centers.

Clinical management of Australian adolescents and young adults with acute lymphoblastic and myeloid leukemias: A national population‐based study

“…The Australian ALL 5‐year survival estimates are similar to those reported from France and the United Kingdom and better than those reported for similarly aged patients from the United States . We found almost a halving of the hazard ratio associated with OS, and reductions between 33% and 40% for EFS and RFS, for ALL patients treated on pediatric‐type protocols compared to those on an adult protocol.…”

“…Comparisons of 5‐year survival rate for AML patients in our study with other work is problematic due to differences in diagnosis periods. A study of Californian 15‐ to 21‐year‐olds diagnosed between 1996 and 2008 found a 5‐year survival rate of 49% . Another study comparing AML survival between Germany and the United States, reported 5‐year survival for 15‐ to 24‐year‐olds diagnosed between 1997 and 2011 was 55% in the United States and 65% in Germany .…”

“…This contrasts U.S. data showing that only around 28% of 15-to 24-year-olds with ALL treated in adult settings were on pediatric protocols. 8 Unfortunately, as previous studies have examined treatment location rather than protocol, 23,24 have not assessed actual treatment patterns, 25 or have examined appropriateness of total care, there are few studies with which we can compare our data. Our data suggest that, at least by the late 2000s, most hematologists working at adult centers in Australia had incorporated the growing body of evidence for treating AYA ALL patients on pediatric protocols into their clinical practice.…”

Acute myelogenous leukemia in adolescents and young adults

“…A relatively low number of AYA are enrolled in adult cooperative group trials or pediatric trials. Treatment protocols for children and adults often differ, and studies on appropriate therapy specifically for AYA are limited . In this review, we describe biological features, treatment modalities, and outcomes of AYA with AML.…”

Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute‐designated cancer centers in California

“…This study, however, was limited to facilities in Los Angeles county and did not consider early mortality. 14 …”