Patterns of care and outcomes in adolescent and young adult acute lymphoblastic leukemia: a population-based study

Lori Muffly, Elysia Alvarez, Daphne Lichtensztajn, Renata Abrahão, Scarlett Lin Gomez, Theresa H Keegan

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Adolescents and young adults (AYAs, 15-39 years) with acute lymphoblastic leukemia (ALL) represent a heterogeneous population who receive care in pediatric or adult cancer settings. Using the California Cancer Registry, we describe AYA ALL patterns of care and outcomes over the past decade. Sociodemographics, treatment location, and front-line therapies administered to AYAs diagnosed with ALL between 2004 and 2014 were obtained. Cox regression models evaluated associations between ALL setting and regimen and overall survival (OS) and leukemia-specific survival (LSS) for the entire cohort, younger AYA (<25 years), and AYAs treated in the adult cancer setting only. Of 1473 cases, 67.7% were treated in an adult setting; of these, 24.8% received a pediatric ALL regimen and 40.7% were treated at a National Cancer Institute (NCI)-designated center. In multivariable analyses, front-line treatment in a pediatric (vs adult) setting (OS HR = 0.53, 95% confidence interval [CI], 0.37-0.76; LSS HR = 0.51, 95% CI, 0.35-0.74) and at an NCI/Children's Oncology Group (COG) center (OS HR = 0.80, 95% CI, 0.66-0.96; LSS HR = 0.80, 95% CI, 0.65-0.97) were associated with significantly superior survival. Results were similar when analyses were limited to younger AYAs. Outcomes for AYAs treated in an adult setting did not differ following front-line pediatric or adult ALL regimens. Our population-level findings demonstrate that two-thirds of AYAs with newly diagnosed ALL are treated in an adult cancer setting, with the majority receiving care in community settings. Given the potential survival benefits, front-line treatment of AYA ALL at pediatric and/or NCI/COG-designated cancer centers should be considered.

Original languageEnglish (US)
Pages (from-to)895-903
Number of pages9
JournalBlood advances
Volume2
Issue number8
DOIs
StatePublished - Apr 24 2018

Fingerprint

Precursor Cell Lymphoblastic Leukemia-Lymphoma
Young Adult
Population
National Cancer Institute (U.S.)
Pediatrics
Confidence Intervals
Leukemia
Neoplasms
Therapeutics
Proportional Hazards Models
Registries

Cite this

Patterns of care and outcomes in adolescent and young adult acute lymphoblastic leukemia : a population-based study. / Muffly, Lori; Alvarez, Elysia; Lichtensztajn, Daphne; Abrahão, Renata; Gomez, Scarlett Lin; Keegan, Theresa H.

In: Blood advances, Vol. 2, No. 8, 24.04.2018, p. 895-903.

Research output: Contribution to journalArticle

Muffly, Lori ; Alvarez, Elysia ; Lichtensztajn, Daphne ; Abrahão, Renata ; Gomez, Scarlett Lin ; Keegan, Theresa H. / Patterns of care and outcomes in adolescent and young adult acute lymphoblastic leukemia : a population-based study. In: Blood advances. 2018 ; Vol. 2, No. 8. pp. 895-903.
@article{73257c100ecd4c38a7ea146a125423b1,
title = "Patterns of care and outcomes in adolescent and young adult acute lymphoblastic leukemia: a population-based study",
abstract = "Adolescents and young adults (AYAs, 15-39 years) with acute lymphoblastic leukemia (ALL) represent a heterogeneous population who receive care in pediatric or adult cancer settings. Using the California Cancer Registry, we describe AYA ALL patterns of care and outcomes over the past decade. Sociodemographics, treatment location, and front-line therapies administered to AYAs diagnosed with ALL between 2004 and 2014 were obtained. Cox regression models evaluated associations between ALL setting and regimen and overall survival (OS) and leukemia-specific survival (LSS) for the entire cohort, younger AYA (<25 years), and AYAs treated in the adult cancer setting only. Of 1473 cases, 67.7{\%} were treated in an adult setting; of these, 24.8{\%} received a pediatric ALL regimen and 40.7{\%} were treated at a National Cancer Institute (NCI)-designated center. In multivariable analyses, front-line treatment in a pediatric (vs adult) setting (OS HR = 0.53, 95{\%} confidence interval [CI], 0.37-0.76; LSS HR = 0.51, 95{\%} CI, 0.35-0.74) and at an NCI/Children's Oncology Group (COG) center (OS HR = 0.80, 95{\%} CI, 0.66-0.96; LSS HR = 0.80, 95{\%} CI, 0.65-0.97) were associated with significantly superior survival. Results were similar when analyses were limited to younger AYAs. Outcomes for AYAs treated in an adult setting did not differ following front-line pediatric or adult ALL regimens. Our population-level findings demonstrate that two-thirds of AYAs with newly diagnosed ALL are treated in an adult cancer setting, with the majority receiving care in community settings. Given the potential survival benefits, front-line treatment of AYA ALL at pediatric and/or NCI/COG-designated cancer centers should be considered.",
author = "Lori Muffly and Elysia Alvarez and Daphne Lichtensztajn and Renata Abrah{\~a}o and Gomez, {Scarlett Lin} and Keegan, {Theresa H}",
year = "2018",
month = "4",
day = "24",
doi = "10.1182/bloodadvances.2017014944",
language = "English (US)",
volume = "2",
pages = "895--903",
journal = "Blood advances",
issn = "2473-9529",
publisher = "American Society of Hematology",
number = "8",

}

TY - JOUR

T1 - Patterns of care and outcomes in adolescent and young adult acute lymphoblastic leukemia

T2 - a population-based study

AU - Muffly, Lori

AU - Alvarez, Elysia

AU - Lichtensztajn, Daphne

AU - Abrahão, Renata

AU - Gomez, Scarlett Lin

AU - Keegan, Theresa H

PY - 2018/4/24

Y1 - 2018/4/24

N2 - Adolescents and young adults (AYAs, 15-39 years) with acute lymphoblastic leukemia (ALL) represent a heterogeneous population who receive care in pediatric or adult cancer settings. Using the California Cancer Registry, we describe AYA ALL patterns of care and outcomes over the past decade. Sociodemographics, treatment location, and front-line therapies administered to AYAs diagnosed with ALL between 2004 and 2014 were obtained. Cox regression models evaluated associations between ALL setting and regimen and overall survival (OS) and leukemia-specific survival (LSS) for the entire cohort, younger AYA (<25 years), and AYAs treated in the adult cancer setting only. Of 1473 cases, 67.7% were treated in an adult setting; of these, 24.8% received a pediatric ALL regimen and 40.7% were treated at a National Cancer Institute (NCI)-designated center. In multivariable analyses, front-line treatment in a pediatric (vs adult) setting (OS HR = 0.53, 95% confidence interval [CI], 0.37-0.76; LSS HR = 0.51, 95% CI, 0.35-0.74) and at an NCI/Children's Oncology Group (COG) center (OS HR = 0.80, 95% CI, 0.66-0.96; LSS HR = 0.80, 95% CI, 0.65-0.97) were associated with significantly superior survival. Results were similar when analyses were limited to younger AYAs. Outcomes for AYAs treated in an adult setting did not differ following front-line pediatric or adult ALL regimens. Our population-level findings demonstrate that two-thirds of AYAs with newly diagnosed ALL are treated in an adult cancer setting, with the majority receiving care in community settings. Given the potential survival benefits, front-line treatment of AYA ALL at pediatric and/or NCI/COG-designated cancer centers should be considered.

AB - Adolescents and young adults (AYAs, 15-39 years) with acute lymphoblastic leukemia (ALL) represent a heterogeneous population who receive care in pediatric or adult cancer settings. Using the California Cancer Registry, we describe AYA ALL patterns of care and outcomes over the past decade. Sociodemographics, treatment location, and front-line therapies administered to AYAs diagnosed with ALL between 2004 and 2014 were obtained. Cox regression models evaluated associations between ALL setting and regimen and overall survival (OS) and leukemia-specific survival (LSS) for the entire cohort, younger AYA (<25 years), and AYAs treated in the adult cancer setting only. Of 1473 cases, 67.7% were treated in an adult setting; of these, 24.8% received a pediatric ALL regimen and 40.7% were treated at a National Cancer Institute (NCI)-designated center. In multivariable analyses, front-line treatment in a pediatric (vs adult) setting (OS HR = 0.53, 95% confidence interval [CI], 0.37-0.76; LSS HR = 0.51, 95% CI, 0.35-0.74) and at an NCI/Children's Oncology Group (COG) center (OS HR = 0.80, 95% CI, 0.66-0.96; LSS HR = 0.80, 95% CI, 0.65-0.97) were associated with significantly superior survival. Results were similar when analyses were limited to younger AYAs. Outcomes for AYAs treated in an adult setting did not differ following front-line pediatric or adult ALL regimens. Our population-level findings demonstrate that two-thirds of AYAs with newly diagnosed ALL are treated in an adult cancer setting, with the majority receiving care in community settings. Given the potential survival benefits, front-line treatment of AYA ALL at pediatric and/or NCI/COG-designated cancer centers should be considered.

UR - http://www.scopus.com/inward/record.url?scp=85051843993&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051843993&partnerID=8YFLogxK

U2 - 10.1182/bloodadvances.2017014944

DO - 10.1182/bloodadvances.2017014944

M3 - Article

C2 - 29669756

AN - SCOPUS:85051843993

VL - 2

SP - 895

EP - 903

JO - Blood advances

JF - Blood advances

SN - 2473-9529

IS - 8

ER -