1
|
Parsons HM, Muffly LS, Garcia A, Zhang A, Miller K, Van Riper D, Knowles K, Keegan TH. Travel-time barriers to specialized cancer care for adolescents and young adults with acute lymphoblastic leukemia. JNCI Cancer Spectr 2024; 8:pkae046. [PMID: 38845074 PMCID: PMC11229987 DOI: 10.1093/jncics/pkae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/11/2024] [Accepted: 05/27/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Prior studies demonstrate that 20%-50% of adolescents and young adults (age 15-39 years) with acute lymphoblastic leukemia (ALL) receive care at specialty cancer centers, yet a survival benefit has been observed for patients at these sites. Our objective was to identify patients at risk of severe geographic barriers to specialty cancer center-level care. METHODS We used data from the North American Association of Central Cancer Registries Cancer in North America database to identify adolescent and young adult ALL patients diagnosed between 2004 and 2016 across 43 US states. We calculated driving distance and travel time from counties where participants lived to the closest specialty cancer center sites. We then used multivariable logistic regression models to examine the relationship between sociodemographic characteristics of counties where adolescent and young adult ALL patients resided and the need to travel more than 1 hour to obtain care at a specialty cancer center. RESULTS Among 11 813 adolescent and young adult ALL patients, 43.4% were aged 25-39 years, 65.5% were male, 32.9% were Hispanic, and 28.7% had public insurance. We found 23.6% of adolescent and young adult ALL patients from 60.8% of included US counties would be required to travel more than 1 hour one way to access a specialty cancer center. Multivariable models demonstrate that patients living in counties that are nonmetropolitan, with lower levels of educational attainment, with higher income inequality, with lower internet access, located in primary care physician shortage areas, and with fewer hospitals providing chemotherapy services are more likely to travel more than 1 hour to access a specialty cancer center. CONCLUSIONS Substantial travel-related barriers exist to accessing care at specialty cancer centers across the United States, particularly for patients living in areas with greater concentrations of historically marginalized communities.
Collapse
Affiliation(s)
- Helen M Parsons
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lori S Muffly
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, CA, USA
| | - Ariadna Garcia
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Amy Zhang
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Kate Miller
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - David Van Riper
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Kate Knowles
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Theresa H Keegan
- Department of Internal Medicine, Division of Hematology/Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| |
Collapse
|
2
|
Trama A, Botta L, Stiller C, Visser O, Cañete-Nieto A, Spycher B, Bielska-Lasota M, Katalinic A, Vener C, Innos K, Marcos-Gragera R, Paapsi K, Guevara M, Demuru E, Mousavi SM, Blum M, Eberle A, Ferrari A, Bernasconi A, Lasalvia P. Survival of European adolescents and young adults diagnosed with cancer in 2010-2014. Eur J Cancer 2024; 202:113558. [PMID: 38489859 DOI: 10.1016/j.ejca.2024.113558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND We used the comprehensive definition of AYA (age 15 to 39 years) to update 5-year relative survival (RS) estimates for AYAs in Europe and across countries and to evaluate improvements in survival over time. METHODS We used data from EUROCARE-6. We analysed 700,000 AYAs with cancer diagnosed in 2000-2013 (follow-up to 2014). We focused the analyses on the 12 most common cancers in AYA. We used period analysis to estimate 5-year RS in Europe and 5-year RS differences in 29 countries (2010-2014 period estimate) and over time (2004-06 vs. 2010-14 period estimates). FINDINGS 5-year RS for all AYA tumours was 84%, ranging from 70% to 90% for most of the 12 tumours analysed. The exceptions were acute lymphoblastic leukaemia, acute myeloid leukaemia, and central nervous system tumours, presenting survival of 59%, 61%, and 62%, respectively. Differences in survival were observed among European countries for all cancers, except thyroid cancers and ovarian germ-cell tumours. Survival improved over time for most cancers in the 15- to 39-year-old age group, but for fewer cancers in adolescents and 20- to 29-year-olds. INTERPRETATION This is the most comprehensive study to report the survival of 12 cancers in AYAs in 29 European countries. We showed variability in survival among countries most likely due to differences in stage at diagnosis, access to treatment, and lack of referral to expert centres. Survival has improved especially for haematological cancers. Further efforts are needed to improve survival for other cancers as well, especially in adolescents.
Collapse
Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venenzian 1, 20133 Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venenzian 1, 20133 Milan, Italy
| | - Charles Stiller
- National Disease Registration Service, NHS England, 7-8 Wellington Place, Leeds LS1 4AP, UK
| | - Otto Visser
- Netherlands Comprehensive Cancer Organization, P.O. Box 19079, 3501 DB Utrecht, Netherlands
| | - Adela Cañete-Nieto
- Spanish Registry of Childhood Tumours, University of Valencia, University of Valencia, Spain; Department of Paediatrics, University of Valencia, Avda. V. Blasco Ibañez, 15, 46010 Valencia, Spain
| | - Ben Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | | | - Alexander Katalinic
- University of Lübeck, Institute for Social Medicine and Epidemiology, Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Claudia Vener
- Epidemiology and Preventive Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venenzian 1, 20133 Milan, Italy
| | - Kaire Innos
- National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), Universitat de Girona, Girona, Spain; Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Group of Descriptive and Analytical Epidemiology of Cancer, Josep Carreras Leukemia Research Institute, Carrer del Sol, 15 1era planta, 17004 Girona, Spain
| | - Keiu Paapsi
- National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Marcela Guevara
- Instituto de Salud Pública y Laboral de Navarra, 31003 Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Elena Demuru
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | | | - Marcel Blum
- Cancer Registry East Switzerland, Flurhofstr. 7 9000 St., Gallen, Switzerland
| | - Andrea Eberle
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venenzian, 1, 20133 Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Epidemiology and Data Science Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venenzian 1, 20133 Milan, Italy.
| | - Paolo Lasalvia
- Evaluative Epidemiology Unit, Epidemiology and Data Science Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venenzian 1, 20133 Milan, Italy
| |
Collapse
|
3
|
Wolfson JA, Grimes AC, Nuno M, Bergheimer CL, Ramakrishnan S, Beauchemin M, Dickens D, Levine JM, Roth ME, Scialla M, Woods W, Vargas S, Boayue KB, Chang GJ, Stock W, Hershman D, Curran E, Advani A, O’Dwyer K, Luger S, Liu JJ, Freyer D, Sung L, Parsons SK. Characteristics of Health Care Settings Where Adolescents and Young Adults Receive Care for ALL. JCO Oncol Pract 2024; 20:491-502. [PMID: 38252911 PMCID: PMC11085951 DOI: 10.1200/op.23.00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Individuals diagnosed with cancer between 15 and 39 years (adolescent and young adult [AYA]) face unique vulnerability. Detail is lacking about care delivery for these patients, especially those with ALL. We address these knowledge gaps by describing AYA ALL care delivery details at National Cancer Institute Community Oncology Research Program (NCORP) (sub)affiliates by model of care. METHODS Participating institutions treated at least one AYA with ALL from 2012 to 2016. Study-specific criteria were used to determine the number of unique clinical facilities (CFs) per NCORP and their model of care (adult/internal medicine [IM], pediatric, mixed [both]). Surveys completed by NCORPs for each CF by model of care captured size, resources, services, and communication. RESULTS Among 84 participating CFs (adult/IM, n=47; pediatric, n=15; mixed, n=24), 34% treated 5-10 AYAs with ALL annually; adult/IM CFs more often treated <5 (adult/IM, 60%; pediatric, 40%; mixed, 29%). Referral decisions were commonly driven by an age/diagnosis combination (58%), with frequent ALL-specific age minimums (87%) or maximums (80%). Medical, navigational, and social work services were similar across models while psychology was available at more pediatric CFs (pediatric, 80%; adult/IM, 40%; mixed, 46%-54%). More pediatric or mixed CFs reported oncologists interacting with pediatric/adult counterparts via tumor boards (pediatric, 93%; adult/IM, 26%; mixed, 96%) or initiating contact (pediatric, 100%; adult/IM, 77%; mixed 96%); more pediatric CFs reported an affiliated counterpart (pediatric, 53%; adult, 19%). Most CFs reported no AYA-specific resources (79%) or meetings (83%-98%). CONCLUSION System-level aspects of AYA ALL care delivery have not been examined previously. At NCORPs, these characteristics differ by models of care. Additional work is ongoing to investigate the impact of these facility-level factors on guideline-concordant care in this population. Together, these findings can inform a system-level intervention for diverse practice settings.
Collapse
Affiliation(s)
- Julie A. Wolfson
- Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Allison C. Grimes
- Division of Pediatric Hematology-Oncology, University of Texas Health Science Center San Antonio
| | - Michelle Nuno
- Children’s Oncology Group
- Department of Population and Public Health Sciences, University of Southern California
| | | | | | | | - David Dickens
- Division of Pediatric Hematology-Oncology, University of Iowa
| | - Jennifer M. Levine
- Division of Pediatric Hematology-Oncology, Children’s National Medical Center
| | - Michael E. Roth
- Division of Pediatric Hematology-Oncology, MD Anderson Cancer Center
| | | | - Wendy Woods
- Division of Pediatric Hematology-Oncology, Blank Children’s Hospital
| | | | - Koh B. Boayue
- Division of Pediatric Hematology-Oncology, University of New Mexico Cancer Center
| | - George J. Chang
- Alliance Cancer Care Delivery Research; Department of Colon and Rectal Surgery and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center
| | - Wendy Stock
- Alliance Leukemia; Division of Hematology-Oncology, University of Chicago Medicine
| | - Dawn Hershman
- SWOG Cancer Care Delivery Research; Division of Hematology-Oncology, Columbia University
| | - Emily Curran
- Alliance Leukemia; Division of Hematology-Oncology, University of Cincinnati
| | - Anjali Advani
- SWOG Leukemia; Division of Hematologic Oncology and Blood Disorders, Cleveland Clinic, Taussig Cancer Institute
| | - Kristen O’Dwyer
- SWOG Leukemia; Division of Hematology-Oncology, University of Rochester, Wilmot Cancer Institute
| | - Selina Luger
- ECOG-ACRIN Leukemia, Division of Hematology-Oncology, University of Pennsylvania
| | - Jane Jijun Liu
- Alliance Community Oncology; Heartland NCORP, Division of Hematology-Oncology, Illinois CancerCare
| | - David Freyer
- Division of Pediatric Hematology-Oncology, Children’s Hospital Los Angeles
| | - Lillian Sung
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children
| | - Susan K. Parsons
- Division of Hematology/Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
| |
Collapse
|
4
|
Ashouri K, Nittur V, Ginosyan AA, Hwang J, Adnani B, Chen D, Savitala-Damerla L, Schiff K, Chaudhary P, Kovach AE, Ladha A, Siddiqi I, Ali A, Woan K, Tam E, Yaghmour G. Concordance of Next-Generation Sequencing and Multiparametric Flow Cytometry Methods for Detecting Measurable Residual Disease in Adult Acute Lymphoblastic Leukemia: Optimizing Prediction of Clinical Outcomes From a Single-Center Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e59-e66.e2. [PMID: 38061959 DOI: 10.1016/j.clml.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Detection of measurable residual disease (MRD) in adults with acute lymphoblastic leukemia (ALL) is a vital biomarker in risk prediction and treatment selection. Next-generation sequencing (NGS) offers greater sensitivity relative to multiparametric flow cytometry (MFC) and may be a better predictive tool for identifying ALL patients at risk of relapse. PATIENTS AND METHODS This single-center retrospective study compares MRD detection by NGS versus MFC in 52 adult B- and T-ALL patients treated at our institution between 2018 and 2023. Pretreatment bone marrow samples were used for assay calibration, while post-treatment MRD assessment was completed up to 4.5 months after the first complete remission (CR1) using an MRD cutoff of 10-6 for distinguishing relapse risk. RESULTS The 2-year cumulative incidence of relapse (CIR) among patients who were MRD positive using MFC and NGS was 39.5% and 46.2%, respectively. Unlike MFC, post-CR1 MRD positivity with NGS significantly predicted CIR (HR = 9.47, P = .028). In patients who were MRD negative by MFC, low levels of MRD detected by NGS distinguished patients at high risk of relapse (HR 10.3, P = .026, 2-year CIR 51.6%). CONCLUSION Our data suggests that assessment of post-CR1 MRD using a highly sensitive NGS assay can identify ALL patients undergoing frontline therapy at increased risk of relapse and guide the use of adjuvant therapy.
Collapse
Affiliation(s)
- Karam Ashouri
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Vinay Nittur
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anush A Ginosyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jennifer Hwang
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Blake Adnani
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Denaly Chen
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Lakshmi Savitala-Damerla
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Kimberly Schiff
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Preet Chaudhary
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Alexandra E Kovach
- Keck School of Medicine, University of Southern California, Los Angeles, CA; Hematopathology, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Abdullah Ladha
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Imran Siddiqi
- Keck School of Medicine, University of Southern California, Los Angeles, CA; Division of Pathology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Amir Ali
- Department of Pharmacy, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Karrune Woan
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Eric Tam
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA.
| |
Collapse
|
5
|
Newman H, Hunger SP. Future of Treatment of Adolescents and Young Adults With ALL: A Vision for Collaboration and Equity. J Clin Oncol 2024; 42:665-674. [PMID: 37890130 DOI: 10.1200/jco.23.01351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/03/2023] [Accepted: 08/30/2023] [Indexed: 10/29/2023] Open
Abstract
Over the past several decades, survival of children with ALL has improved dramatically with treatment regimens refined through cooperative group trials. Despite aggressive treatment and iterative therapy changes for adolescents and young adults (AYAs), improvement has not been as promising. Comparisons between pediatric and adult clinical trials have consistently demonstrated superior outcomes for AYAs treated on pediatric ALL protocols, leading to the implementation of pediatric-inspired ALL protocols by several groups worldwide and/or expansion of the age limit of pediatric trials to include the full spectrum of the AYA population. Despite these efforts, AYAs in both pediatric and adult settings continue to have inferior survival compared with younger children with ALL. Real-world data suggest that uptake of pediatric-style treatment is variable, and even with identical pediatric-style treatment, AYAs still fare worse than younger children. As we enter an era of immunotherapy and precision medicine for newly diagnosed ALL, now is an opportune time to consider how best to approach future therapy for AYA patients. Comparisons of pediatric and adult treatment approaches and subanalyses of AYA patients will help guide harmonization of treatment. The focus of the next stage of ALL therapy for AYA should not only involve novel treatment approaches but also standardization and optimization of supportive care measures, psychosocial support, adherence interventions, oncofertility treatment, and survivorship care. All these efforts should simultaneously work to address health disparities to ensure that a future of improved outcomes is experienced equitably for all AYA patients.
Collapse
Affiliation(s)
- Haley Newman
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephen P Hunger
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
6
|
Alfraih F, Absi A, Abuhaleeqa M, Alghamdi K, Alhuraiji A, Al‐Khabori M, Al‐Shaibani Z, Alzahrani M, Cherif H, Eldadah S, Hanbali A, Motabi IH, Salama H. Management of adult acute lymphoblastic leukemia in the Gulf Cooperation Council (GCC) countries: A consensus report from the GCC Adult ALL Working Group. Cancer Rep (Hoboken) 2024; 7:e1931. [PMID: 38083985 PMCID: PMC10849924 DOI: 10.1002/cnr2.1931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/22/2023] [Accepted: 11/05/2023] [Indexed: 02/12/2024] Open
Abstract
Leukemia burden is growing in the Gulf Council Cooperation (GCC) countries. Nonetheless, there is no unified protocol for managing adult acute lymphoblastic leukemia (ALL) patients in the GCC-countries. Therefore, the GCC Adult-ALL Treaters working group developed this consensus to address the adult-ALL treatment protocols in the GCC-countries and related toxicities' management. Besides, the consensus aimed to highlight the current unmet needs and treatment gaps and provide recommendations to optimize adult-ALL care and patient-centered communication. A three-step modified Delphi method to develop evidence-based recommendations through two-voting rounds and in-between virtual meetings are used in the manuscript development. A 12 experts' panel from five GCC-countries and two international experts were invited to participate in this consensus. This consensus consisted of 35-statements that highlighted the experts' recommendations to optimize ALL adults' care in the first line setting and manage pediatric or pediatric-inspired regimens-related toxicities. Besides, guidance was provided for future research direction and improve patient-centered communication. In conclusion, the adult-ALL management landscape is evolving, and the current evidence highlights better response and survival outcomes with pediatric or pediatric-inspired regiments. Therefore, protocols are needed to optimize the adult-ALL management in the GCC and tailored clinical-trials findings according to the GCC patients' characteristics and local-healthcare infrastructure.
Collapse
Affiliation(s)
- Feras Alfraih
- King Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
- Al Faisal UniversityRiyadhSaudi Arabia
| | - Ahmed Absi
- Princess Noorah Oncology CenterKing Abdulaziz Medical City, Ministry of National Guard Health AffairsJeddahSaudi Arabia
| | | | | | - Ahmad Alhuraiji
- Department of HematologyKuwait Cancer Control CenterKuwait CityKuwait
| | - Murtadha Al‐Khabori
- Department of Hematology, College of Medicine and Health SciencesSultan Qaboos UniversityMuscatOman
| | - Zeyad Al‐Shaibani
- King Faisal Specialist Hospital and Research CentreMadinahSaudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Honar Cherif
- National Center for Cancer Care and ResearchHamad Medical CooperationDohaQatar
| | - Saleem Eldadah
- Princess Noorah Oncology CenterKing Abdulaziz Medical City, Ministry of National Guard Health AffairsJeddahSaudi Arabia
| | - Amr Hanbali
- King Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | | | - Hind Salama
- King Abdulaziz‐Medical CityRiyadhSaudi Arabia
| |
Collapse
|
7
|
Janardan SK, Miller TP. Adolescents and young adults (AYAs) vs pediatric patients: survival, risks, and barriers to enrollment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:581-586. [PMID: 38066874 PMCID: PMC10727024 DOI: 10.1182/hematology.2023000507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Adolescents and young adults (AYAs; ages 15-39 years) with acute lymphoblastic leukemia (ALL) have worse outcomes than pediatric patients with ALL. Multiple factors contribute to this differential survival. AYAs are more likely to have higher-risk leukemia biology than children with ALL. AYA patients have more choices for treatment facility and treatment protocol, as well as barriers to clinical trial enrollment, both of which can affect survival. AYAs must also navigate psychosocial factors inherent to their unique developmental stage. Furthermore, AYAs typically sustain more treatment-related toxicities than pediatric patients. Treatment on pediatric or pediatric-inspired ALL protocols at pediatric cancer centers has been associated with improved outcomes for AYAs with ALL, but there is still variation in the treatment that AYAs with ALL receive. Clinical trials focused on AYAs with ALL and individualized decision-making regarding choice of treatment facility and treatment protocol are needed to optimize the survival and long-term outcomes of this patient population.
Collapse
Affiliation(s)
- Sanyukta K Janardan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Tamara P Miller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
8
|
Muffly LS, Parsons HM, Miller K, Li Q, Brunson A, Keegan TH. Impact of Specialized Treatment Setting on Survival in Adolescent and Young Adult ALL. JCO Oncol Pract 2023; 19:1190-1198. [PMID: 37890123 DOI: 10.1200/op.23.00373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/28/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Unlike children with ALL who receive cancer care primarily at specialized cancer centers (SCCs; National Cancer Institute and/or Children's Oncology Group centers), adolescents and young adults (AYAs; 15-39 years) receive care in a variety of settings. Using population-based data, we describe where AYAs with ALL receive treatment and determine associations with overall survival (OS). METHODS Data from the 2004 to 2018 California (CA, n = 2,283), New York (NY, n = 795), and Texas (TX, n = 955) state cancer registries were used to identify treatment setting of AYAs with newly diagnosed ALL. Multivariable Cox proportional hazards regression models evaluated associations with OS. RESULTS Seventy percent were older than 18 years, and 65% were male. A majority in CA (63%) and TX (64%) were Hispanic while most in NY were non-Hispanic White (50%). Treatment at an SCC occurred in 48.2% (CA), 44.4% (NY), and 19.5% (TX). Across states, AYAs who were older or uninsured were less likely to receive treatment at an SCC. Treatment at an SCC was associated with superior OS in CA (hazard ratio [HR], 0.73; 95% CI, 0.63 to 0.85) and TX (HR, 0.61; 95% CI, 0.45 to 0.83); a nonsignificant association was seen in NY (HR, 0.83; 95% CI, 0.64 to 1.08). CONCLUSION Only 20%-50% of AYA patients with ALL received frontline treatment at SCCs. Treatment of ALL at an SCC was associated with superior survival, highlighting the importance of policy efforts to improve access and reduce inequities in AYA ALL care.
Collapse
Affiliation(s)
- Lori S Muffly
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, CA
| | - Helen M Parsons
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Kate Miller
- Quantitative Sciences Unit, Stanford University, Stanford, CA
| | - Qian Li
- Division of Hematology/Oncology, University of California Davis, Davis, CA
| | - Ann Brunson
- Division of Hematology/Oncology, University of California Davis, Davis, CA
| | - Theresa H Keegan
- Division of Hematology/Oncology, University of California Davis, Davis, CA
| |
Collapse
|
9
|
Abdulaziz-Opiela G, Sobieraj A, Płotka A, Więckowska B, Gil L, Derwich K. Comparison of diagnostic and treatment processes among pediatric and adolescents and young adults' populations suffering from acute lymphoblastic leukemia and lymphomas. Front Oncol 2023; 13:1082789. [PMID: 36824131 PMCID: PMC9941624 DOI: 10.3389/fonc.2023.1082789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Acute lymphoblastic leukemia (ALL) and lymphomas affect both pediatric and adult populations, therefore, they might be treated by pediatric or adult centers.It has been proven that the prognosis among adolescents and young adults (AYA) is poorer than among children, which remains a subject of research. Many factors are suspected to affect the diagnostic and treatment processes in adolescents and young adults, one of them being the organization of the healthcare system.The aimof the studywas to compare the time intervals between different events on disease trajectory in pediatric and AYA groups suffering from ALL and lymphomas. Methods We collected data on 81 patients diagnosed with ALL (50 children and 31 AYAs) and 100 patients diagnosed with lymphomas (50 children and 50 AYAs). Statistical analysis was performed in order to compare the groups. Results The results confirmed the hypothesis that the duration of the diagnostic process differs significantly between groups. For patients with ALL, the analyzed time intervals were significantly shorter in the pediatric group than in the AYA group: first contact with a GP - admission to Hematology Department (2 vs. 5 days; pvalue= 0.004), first contact with a GP - treatment (6 vs. 12 days, p-value=0.001), diagnosis - treatment (1 vs. 3 days, p-value=0.003). In the case of patients suffering from lymphomas, the results were similar. The analyzed time intervals were significantly shorter in the pediatric group than in the AYA group: first contact with a GP- diagnosis (21 vs. 40.5 days, p-value<0.0001), first contact with a GP - treatment (27 vs. 65 days, p-value<0.0001). Trend analysis showed that the longer patients had presented symptoms before contacting the primary care physician, the longer they waited for the beginning of treatment both in ALL and lymphomas groups (p-values=0.0129 and 0.0038 respectively). Discussion As the diagnostic and treatment processes are longer for AYA patients, actions must be undertaken in order to ensure equality and improve the healthcare system in Poland and possibly other countries.
Collapse
Affiliation(s)
- Gazala Abdulaziz-Opiela
- Poznan University of Medical Sciences, Poznan, Poland,*Correspondence: Gazala Abdulaziz-Opiela,
| | - Anna Sobieraj
- Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Płotka
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
10
|
Kasonkanji E, Kimani S, Skiver B, Ellis G, Seguin R, Kaimila B, Tomoka T, Mulenga M, Montgomery N, Fedoriw Y, Gopal S, Westmorland KD, Painschab MS. Clinical Characteristics and Outcomes of Acute Lymphoblastic Leukemia in Adolescents and Young Adults in Malawi. JCO Glob Oncol 2022; 8:e2100388. [PMID: 35772043 PMCID: PMC9276115 DOI: 10.1200/go.21.00388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There are limited data on treatment and outcomes for acute lymphoblastic leukemia (ALL) among adolescents and young adults in sub-Saharan Africa. We describe a prospective observational cohort in Malawi.
Collapse
Affiliation(s)
| | - Stephen Kimani
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Grace Ellis
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| | - Ryan Seguin
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Bongani Kaimila
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tamiwe Tomoka
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Nathan Montgomery
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| | - Yuri Fedoriw
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD
| | - Katherine D. Westmorland
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| | - Matthew S. Painschab
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
11
|
Abrahão R, Cooley JJ, Maguire FB, Parikh-Patel A, Morris CR, Schwarz EB, Wun T, Keegan TH. Stage at diagnosis and survival among adolescents and young adults with lymphomas following the Affordable Care Act implementation in California. Int J Cancer 2022; 150:1113-1122. [PMID: 34800045 PMCID: PMC8810606 DOI: 10.1002/ijc.33880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 12/19/2022]
Abstract
Adolescents and young adults (AYAs, 15-39 years) are the largest uninsured population in the Unites States, increasing the likelihood of late-stage cancer diagnosis and poor survival. We evaluated the associations between the Affordable Care Act (ACA), insurance coverage, stage at diagnosis and survival among AYAs with lymphoma. We used data from the California Cancer Registry linked to Medicaid enrollment files on AYAs diagnosed with a primary non-Hodgkin (NHL; n = 5959) or Hodgkin (n = 5378) lymphoma pre-ACA and in the early and full ACA eras. Health insurance was categorized as continuous Medicaid, discontinuous Medicaid, Medicaid enrollment at diagnosis/uninsurance, other public and private. We used multivariable regression models for statistical analyses. The proportion of AYAs uninsured/Medicaid enrolled at diagnosis decreased from 13.4% pre-ACA to 9.7% with full ACA implementation, while continuous Medicaid increased from 9.3% to 29.6% during this time (P < .001). After full ACA, AYAs with NHL were less likely to be diagnosed with Stage IV disease (adjusted odds ratio [aOR] = 0.84, 95% confidence interval [CI] = 0.73-0.97). AYAs with lymphoma were more likely to receive care at National Cancer Institute-Designated Cancer Centers (aOR = 1.42, 95% CI = 1.28-1.57) and had lower likelihood of death (adjusted hazard ratio = 0.54, 95% CI = 0.46-0.63) after full ACA. However, AYAs from the lowest socioeconomic neighborhoods, racial/ethnic minority groups and those with Medicaid continued to experience worse survival. In summary, AYAs with lymphomas experienced increased access to healthcare and better clinical outcomes following Medicaid expansion under the ACA. Yet, socioeconomic and racial/ethnic disparities remain, calling for additional efforts to decrease health inequities among underserved AYAs with lymphoma.
Collapse
Affiliation(s)
- Renata Abrahão
- Center for Healthcare Policy & Research, University of California Davis, Sacramento-CA
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Davis Comprehensive Cancer Center, Sacramento-CA
| | - Julianne J.P. Cooley
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento-CA
| | - Frances B. Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento-CA
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento-CA
| | - Cyllene R. Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento-CA
| | - Eleonor Bimla Schwarz
- Center for Healthcare Policy & Research, University of California Davis, Sacramento-CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Davis Comprehensive Cancer Center, Sacramento-CA
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Davis Comprehensive Cancer Center, Sacramento-CA
| |
Collapse
|
12
|
Li J. Digestive cancer incidence and mortality among young adults worldwide in 2020: A population-based study. World J Gastrointest Oncol 2022; 14:278-294. [PMID: 35116117 PMCID: PMC8790416 DOI: 10.4251/wjgo.v14.i1.278] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/04/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Digestive cancer has traditionally been thought of as a disease that mainly occurs in elderly individuals, and it has been ignored in young adults by both patients and physicians. AIM To describe the worldwide profile of digestive cancer incidence, mortality and corresponding trends among 20-39-year-olds, with major patterns highlighted by age, sex, development level, and geographical region. METHODS I performed a population-based study to quantify the burden of young adult digestive cancers worldwide. Global, regional, sex, and country-specific data estimates of the number of new cancer cases and cancer-associated deaths that occurred in 2020 were extracted from the GLOBOCAN Cancer Today database. To assess long-term trends in young adult digestive cancer, cancer incidence data and mortality data were obtained from the Cancer in Five Continents Plus database and the World Health Organization mortality database, respectively. The associations between the human development index (HDI) and digestive cancer burden in young adults were evaluated by linear regression analyses. RESULTS In 2020, there were an estimated 19292789 new cancer cases, resulting in 9958133 deaths worldwide, which equated to an age-standardized incidence rate (ASIR) of 5.16 and age-standardized mortality rate (ASMR) of 3.04, accounting for 12.24% of all new cancer cases and 25.26% of all cancer deaths occurring in young adults. The burden was disproportionally greater among males, with male: female ratios of 1.34 for incidence and 1.58 for mortality. The ASIRs were 2.1, 1.4, and 1.0 per 100000 people per year, whereas the ASMRs were 0.83, 1.1, and 0.62 per 100000 people per year for colorectal, liver, and gastric cancer, respectively. When assessed by geographical region and HDI levels, the cancer profile varied substantially, and a strong positive correlation between the mortality-to-incidence ratio of digestive cancer and HDI ranking was found (R 2 = 0.7388, P < 0.001). CONCLUSION The most common digestive cancer types are colorectal, liver and gastric cancer. The global digestive cancer burden among young adults is greater among males and exhibits a positive association with socioeconomic status. The digestive cancer burden is heavy in young adults, reinforcing the need for primary and secondary prevention strategies.
Collapse
Affiliation(s)
- Jian Li
- Department of General Surgery, The Third Hospital of Mianyang, The Mental Health Center of Sichuan, Mianyang 621000, Sichuan Province, China
| |
Collapse
|
13
|
Gupta S, Sutradhar R, Li Q, Coburn N. The effectiveness of a provincial symptom assessment program in reaching adolescents and young adults with cancer: A population-based cohort study. Cancer Med 2021; 10:9030-9039. [PMID: 34738747 PMCID: PMC8683532 DOI: 10.1002/cam4.4401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Symptom control is prioritized by cancer patients and may improve overall survival. Ontario, Canada thus offers all cancer patients screening using the Edmonton Symptom Assessment System (ESAS) at outpatient cancer‐related visits. We determined whether this initiative reached adolescents and young adults (AYA) and factors associated with screening in this population. Methods We linked all Ontario AYA diagnosed with cancer 2010–2018 aged 15–29 years to population‐based databases identifying outpatient visits and ESAS screening. For each 2‐week period in the year post‐diagnosis, AYA with cancer‐related visits were categorized as “unscreened” (no ESAS score) versus “screened” (≥1 ESAS score). Demographic and disease‐related covariates were examined. Results Among 5435 AYA, 4204 (77.4%) had ≥1 ESAS screen. Within any 2‐week period, only 30%–44% of AYA attending cancer‐related visits were screened. Patients with hematologic malignancies were least likely to be screened [odds ratio (OR) vs. breast cancer 0.77, 95% confidence interval (95% CI) 0.67–0.88; p < 0.001]. AYA in remote Northern or rural areas had equivalent or higher rates of ESAS screening compared to those in high‐income urban areas. However, AYA living in the lowest income urban neighborhoods were less likely to be screened (OR 0.86, 95% CI 0.77–0.97; p = 0.01). Conclusions Within a population‐wide symptom assessment program, while AYA living in rural and remote areas had high rates of screening, than those in low‐income urban areas were substantially less likely to be screened. Though patients with hematologic cancers suffer from particularly high symptom burdens, they were also less likely to be screened. Interventions targeting AYA are required to increase uptake.
Collapse
Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Qing Li
- Cancer Research Program, ICES, Toronto, Canada
| | - Natalie Coburn
- Cancer Research Program, ICES, Toronto, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
| |
Collapse
|
14
|
Burke MJ, Devidas M, Chen Z, Salzer WL, Raetz EA, Rabin KR, Heerema NA, Carroll AJ, Gastier-Foster JM, Borowitz MJ, Wood BL, Winick NJ, Carroll WL, Hunger SP, Loh ML, Larsen EC. Outcomes in adolescent and young adult patients (16 to 30 years) compared to younger patients treated for high-risk B-lymphoblastic leukemia: report from Children's Oncology Group Study AALL0232. Leukemia 2021; 36:648-655. [PMID: 34725453 DOI: 10.1038/s41375-021-01460-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 12/31/2022]
Abstract
Adolescent and young adult (AYA) patients 16-30 years old with high-risk acute lymphoblastic leukemia (HR-ALL) have inferior outcomes compared to younger HR-ALL patients. AALL0232 was a Phase 3 randomized Children's Oncology Group trial for newly diagnosed HR B-ALL (1-30 years). Between 2004 and 2011, 3154 patients enrolled with 3040 eligible and evaluable for induction. AYA patients comprised 20% of patients (16-21 years, n = 551; 22-30 years, n = 46). 5-year event-free survival and overall survival was 65.4 ± 2.2% and 77.4 ± 2.0% for AYA patients compared to 78.1 ± 0.9% and 87.3 ± 0.7% for younger patients (p < 0.0001). Five-year cumulative incidence of relapse was 18.5 ± 1.7% for AYA patients and 13.5 ± 0.7% for younger patients (p = 0.006), largely due to increased marrow relapses (14.0 ± 1.5% versus 9.1 ± 0.6%; p < 0.0001). Additionally, induction failure rate was higher in AYA (7.2 ± 1.1% versus 3.5 ± 0.4%; p < 0.001) and post-induction remission deaths were significantly higher in AYA (5.7 ± 1.0% versus 2.4 ± 0.3%; p < 0.0001). AALL0232 enrolled the largest number of AYA B-ALL patients to date, demonstrating significantly inferior survival and greater rates of treatment-related toxicities compared to younger patients. Although treatment intensification has improved outcomes in younger patients, they have not been associated with the same degree of improvement for older patients.
Collapse
Affiliation(s)
- Michael J Burke
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhiguo Chen
- Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Wanda L Salzer
- U.S. Army Medical Research and Materiel Command, Fort Detrick, MD, USA
| | - Elizabeth A Raetz
- Department of Pediatrics, Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Karen R Rabin
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University School of Medicine, Columbus, OH, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Michael J Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Brent L Wood
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Naomi J Winick
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William L Carroll
- Department of Pediatrics, Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Stephen P Hunger
- Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mignon L Loh
- Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA
| | - Eric C Larsen
- Department of Pediatrics, Maine Children's Cancer Program, Scarborough, ME, USA
| |
Collapse
|
15
|
Gupta S, Alexander S, Pole JD, Sutradhar R, Crump M, Nagamuthu C, Baxter NN, Nathan PC. Superior outcomes with paediatric protocols in adolescents and young adults with aggressive B-cell non-Hodgkin lymphoma. Br J Haematol 2021; 196:743-752. [PMID: 34599525 DOI: 10.1111/bjh.17862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022]
Abstract
Survival disparities by locus of care (LOC; paediatric versus adult) among adolescents and young adults (AYA) with acute lymphoblastic leukaemia (ALL) are well documented. Whether similar disparities exist among AYA with aggressive mature B-cell non-Hodgkin lymphoma (B-NHL) is unknown. We identified all Ontario, Canada AYA aged 15-21 years at diagnosis of B-NHL between 1992 and 2012. Demographic, disease, treatment and outcome data were chart abstracted. The impact of LOC on event-free (EFS) and overall survival (OS) were determined, adjusted for patient and disease covariates. Among 176 AYA with B-NHL, 62 (35·2%) received therapy at paediatric centres. The 5-year EFS and OS [± standard error (SE)] for the overall cohort were 72·2 [3·4]% and 76·1 [3·2]% respectively. Both EFS and OS were superior among paediatric centre AYA [EFS (± SE) 82·2 (4·9)% vs. 66·7 (4·4)%, P = 0·02; OS 85·5 (4·5)% vs. 71·1 (4·3)%, P = 0·03]. Adjusted for histology, stage and time period, adult centre AYA had inferior EFS [hazard ratio (HR) 2·4, 95% confidence interval (CI) 1·1-4·9, P = 0·02] and OS (HR 2·5, 95% CI 1·1-5·7, P = 0·03). Sensitivity analyses restricted to the latest time period, when most adult centre AYA received rituximab, demonstrated similar disparities. Similar to AYA with ALL, AYA with B-NHL may benefit from being treated with paediatric protocols. Studies prospectively validating these results are warranted.
Collapse
Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jason D Pole
- Cancer Research Program, ICES, Toronto, ON, Canada.,Center for Health Services Research, University of Queensland, Brisbane, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael Crump
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | | | - Nancy N Baxter
- Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
16
|
Derwich K, Brzezinski A, Karpenko C, Morar V, Atukoralalage U. Acute Lymphoblastic Leukemia in Adolescents and Young Adults: A Polish Perspective. J Adolesc Young Adult Oncol 2021; 11:1-5. [PMID: 34232789 DOI: 10.1089/jayao.2021.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a disease that affects immature lymphocytes in the blood and presents a high prevalence rate in children and adolescent young adult (AYA) populations (15-39 years). AYAs are a unique group who face a significant therapeutic disadvantage when treated with the adult regimen, as evident with lower remission rates, whereas the opposite is true in children. A recent study by EUROCARE-5 showed a marked decrease with age in 5 years relative to survival outcomes based on cancer registries of 27 European countries: 85.8% for patients 0-14 years of age and a decreased 62.2% and 52.8% for patients 15-19 and 20-39 years, respectively. There is growing evidence demonstrating that the pediatric ALL treatment regimen is effective and beneficial when treating AYAs. Treatment of ALL in AYAs around the world is showing improved remission rates with therapeutic advancements and increasing amount of data available with updated clinical trials and regimens. The addition of l-asparaginase into adult treatment regimens has significantly increased the remission rates. This administration to AYAs is more difficult but shows a positive benefit in comparison with the toxicity ratio. This review article will discuss the controversy of AYA patients diagnosed with ALL treated with pediatric or adult protocols and their perspectives in Poland and will focus on ALL etiology, epidemiology, and prognostic factors with comparison of compliance of medications between both populations of patients.
Collapse
Affiliation(s)
- Katarzyna Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | | | | | - Vanisha Morar
- Poznan University of Medical Sciences, Poznań, Poland
| | | |
Collapse
|
17
|
Testi AM, Canichella M, Vitale A, Piciocchi A, Guarini A, Starza ID, Cavalli M, De Propris MS, Messina M, Elia L, Moleti ML, Martino B, Luppi M, D'Aloisio M, Candoni A, Conter V, Fazi P, Vignetti M, Chiaretti S, Foà R. Adolescent and young adult acute lymphoblastic leukemia. Final results of the phase II pediatric-like GIMEMA LAL-1308 trial. Am J Hematol 2021; 96:292-301. [PMID: 33284999 DOI: 10.1002/ajh.26066] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 12/31/2022]
Abstract
Adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) represent a unique patient population with specific characteristics and needs. Growing evidences suggest that pediatric-inspired approaches improve the outcome in AYA. These results prompted the design of a pediatric AIEOP-BFM ALL 2000-based regimen - the GIMEMA LAL-1308 protocol - for newly diagnosed AYA (range 18-35 years) with Philadelphia negative (Ph-) ALL. The protocol included minimal residual disease (MRD) analysis at two different time-points (TP), that is, at the end of induction IA and consolidation IB, and a modulation in post-consolidation intensity according to MRD. Seventy-six patients were eligible between September 2010 and October 2014. The regimen was well tolerated, with 2.7% induction deaths and no deaths in the post-consolidation phase. The complete response (CR) rate was 92%; the 48-month overall survival (OS) and disease-free survival (DFS) were 60.3% and 60.4%. Both OS and DFS were significantly better in T-ALL than B-ALL. A molecular MRD <10-3 at TP1 was associated with a significantly better OS and DFS (77% vs 39% and 71.9% vs 34.4%, respectively);similar results were documented at TP2 (OS and DFS 74.5% vs 30.6% and 71.5% vs 25.7%, respectively). The LAL-1308 results were compared to those from similar historic AYA populations undergoing the two previous GIMEMA LAL-2000 and LAL-0904 protocols. Both OS and DFS improved significantly compared to the two previous protocols. These results indicate that this pediatric-inspired and MRD-oriented protocol is feasible and effective for Ph- AYA ALL patients, and underline the prognostic value of MRD determinations at specific TPs.
Collapse
Affiliation(s)
- Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Martina Canichella
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Antonella Vitale
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | | | - Anna Guarini
- Department of Molecular Medicine Sapienza University Rome Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | | | - Monica Messina
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Loredana Elia
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Bruno Martino
- Azienda Ospedaliera Bianchi‐Melacrinò‐Morelli Reggio Calabria Italy
| | - Mario Luppi
- Azienda Ospedaliera Universitaria di Modena Modena Italy
| | - Marianna D'Aloisio
- Bone Marrow Transplant Center, Department of Hematology Transfusion Center and Biotechnology, Ospedale Civile Pescara Italy
| | - Anna Candoni
- Clinica Ematologica e Unità di Terapie Cellulari 'Carlo Melzi'‐ Azienda Ospedaliera‐Universitaria Udine Italy
| | | | - Paola Fazi
- GIMEMA Data Center GIMEMA Foundation Rome Italy
| | - Marco Vignetti
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Sabina Chiaretti
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Roberto Foà
- Hematology, Department of Translational and Precision Medicine Sapienza University Rome Italy
| |
Collapse
|
18
|
Muffly L, Maguire FB, Li Q, Kennedy V, Keegan TH. Late Effects in Survivors of Adolescent and Young Adult Acute Lymphoblastic Leukemia. JNCI Cancer Spectr 2020; 4:pkaa025. [PMID: 32704618 PMCID: PMC7368465 DOI: 10.1093/jncics/pkaa025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/24/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background Knowledge regarding late effects (medical conditions and subsequent neoplasms) in survivors of adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL) is lacking. Methods Using the population-based California Cancer Registry linked with California hospitalization data, we evaluated late effects in 1069 AYAs (aged 15-39 years) diagnosed with ALL in California between 1995 and 2012 and surviving a minimum of 3 years from diagnosis. Results The estimated 10-year cumulative incidence of subsequent endocrine disease (28.7%, 95% confidence interval [CI] = 25.8% to 31.6%) and cardiac disease (17.0%, 95% CI = 14.6% to 19.5%) were strikingly high; avascular necrosis (9.6%, 95% CI = 7.8% to 11.6%), liver disease (6.5%, 95% CI = 5.0% to 8.3%), respiratory disease (6.2%, 95% CI = 4.8% to 8.0%), seizure and/or stroke (4.3%, 95% CI = 3.1% to 5.8%), renal disease (3.1%, 95% CI = 2.1% to 4.4%), and second neoplasms (1.4%, 95% CI = 0.7% to 2.4%) were estimated to occur at 10 years with the reported frequencies. Multivariable analyses including the entire patient cohort demonstrated that public or no insurance (vs private and/or military insurance) and receipt of hematopoietic cell transplantation were independently associated with the occurrence of all late effects considered. In multivariable analyses limited to the 766 AYAs who were not transplanted, we continued to find a statistically significant association between public and no insurance and the occurrence of all late effects. Frontline regimen type (pediatric vs adult) was not statistically significantly associated with any of the late effect categories. Conclusions This large population-based analysis is among the first to describe late effects in survivors of AYA ALL. The strong association between insurance type and late effects suggests that AYAs with public or no insurance may have reduced access to survivorship care following completion of ALL therapy.
Collapse
Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Medical Center, Stanford, CA, USA
| | - Frances B Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Health, Institute for Population Health Improvement, Sacramento, CA, USA
| | - Qian Li
- Division of Hematology and Oncology, Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Vanessa Kennedy
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Theresa H Keegan
- Division of Hematology and Oncology, Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California, Davis School of Medicine, Sacramento, CA, USA
| |
Collapse
|
19
|
Silva WFD, Massaut IHB, Bendlin RM, Rosa LI, Velloso EDRP, Rego EM, Rocha V. Toxicity Profile of PEG-Asparaginase in Adult Patients With Acute Lymphoblastic Leukemia in Brazil: A Multicenter Cross-Sectional Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e523-e528. [PMID: 32389674 DOI: 10.1016/j.clml.2020.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Currently, pediatric-inspired regimens are commonly applied to adults with acute lymphoblastic leukemia (ALL) after the recent recognition that these protocols improve survival. While asparaginase in whatever available formulation is a key component of modern treatment of ALL, many adult oncologists and hematologists struggle to deal with its particular toxicities in clinical practice. We reviewed toxicity outcomes of pegylated asparaginase (PEG-ASP) in adults with ALL treated in 3 reference centers in Brazil. PATIENTS AND METHODS This was a cross-sectional retrospective chart-review study encompassing patients aged 15 years and older diagnosed with ALL or ambiguous-lineage leukemia who received at least one dose of PEG-ASP, regardless of the adopted regimen. RESULTS A total of 57 patients were included (age range, 15-57 years). Most patients (70%) received 2000 IU/m2 as the initial dose, by intravenous route (72%). The incidence of thromboembolic events was 17.5%, and the main site was cerebral venous sinus (4/10). Thrombosis was more frequent in patients receiving second-line treatment. In obese patients, grade 3 hepatotoxicity and hyperbilirubinemia were more common. Clinical pancreatitis (grade 3 or higher) was found in 2 of 57 cases. PEG-ASP had to be discontinued in 19.3% of exposed patients (11/57). CONCLUSION By reviewing the medical charts of adult patients with ALL from 3 reference centers, we found that our incidence of thrombotic and hepatic adverse events is similar to those reported in other trials involving PEG-ASP. Usually these effects should not preclude further use of the drug because most events are manageable in routine clinical practice.
Collapse
Affiliation(s)
- Wellington F da Silva
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Ires H B Massaut
- Hematologia, Centro de Pesquisas Oncológicas (CEPON), Florianópolis, Brazil
| | - Rodrigo M Bendlin
- Hematologia, Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Lidiane I Rosa
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Elvira D R P Velloso
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Eduardo M Rego
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Vanderson Rocha
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| |
Collapse
|
20
|
Kozak MM, Yoo CH, Gutkin PM, von Eyben R, Agarwal R, Donaldson SS, Muffly L, Hiniker SM. Central Nervous System Relapse After Stem Cell Transplantation in Adolescents and Young Adults with Acute Lymphoblastic Leukemia: A Single-Institution Experience. J Adolesc Young Adult Oncol 2020; 9:166-171. [DOI: 10.1089/jayao.2019.0121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Margaret M. Kozak
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Christopher H. Yoo
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Paulina M. Gutkin
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Rajni Agarwal
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Sarah S. Donaldson
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Lori Muffly
- Division of Blood and Bone Marrow Transplantation, Department of Medicine, Stanford University, Stanford, California
| | - Susan M. Hiniker
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| |
Collapse
|
21
|
Wang AY, Muffly LS, Stock W. Philadelphia Chromosome-Negative B-Cell Acute Lymphoblastic Leukemia in Adolescents and Young Adults. JCO Oncol Pract 2020; 16:231-238. [PMID: 32048928 DOI: 10.1200/jop.19.00197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Adolescents and young adults (AYAs) with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) represent a unique patient population with a disproportionate survival disadvantage compared with younger children. Substantial progress has been made as we began to understand and address the multifaceted drivers behind this outcome disparity. New insights into the biology of B-cell ALL have uncovered distinct genetic characteristics more commonly found in AYAs that affect prognosis. Dramatic improvements in survival have been achieved with the use of pediatric-inspired protocols in the front-line setting, as well as antibody-based and chimeric antigen receptor T-cell therapies in the relapsed and refractory setting. Guided by the incorporation of minimal residual disease testing to inform clinical decision making, these represent major paradigm shifts in management. Efforts to design clinical trials geared toward AYAs and to enroll AYAs in available clinical trials will ensure ongoing progress. Holistic care of AYAs with ALL further involves recognition of psychosocial issues arising as a consequence of their diagnosis and the delivery of age-appropriate supportive care.
Collapse
|
22
|
Siegel SE, Stock W, Johnson RH, Advani A, Muffly L, Douer D, Reed D, Lewis M, Freyer DR, Shah B, Luger S, Hayes-Lattin B, Jaboin JJ, Coccia PF, DeAngelo DJ, Seibel N, Bleyer A. Pediatric-Inspired Treatment Regimens for Adolescents and Young Adults With Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia: A Review. JAMA Oncol 2019; 4:725-734. [PMID: 29450465 DOI: 10.1001/jamaoncol.2017.5305] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance The incidence of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in adolescent and young adult (AYA) patients (age range, 15-39 years) in the United States is increasing at a greater rate than in younger or older persons. Their optimal treatment has been increasingly debated as pediatric regimens have become more widely used in the age group. This review compares the basic features of pediatric and adult chemotherapy regimens for ALL and LBL, recognizes and describes the challenges of the pediatric regimen, and suggests strategies to facilitate its adoption for AYAs with ALL and LBL. Observations All but 2 of 25 published comparisons of outcomes with pediatric and adult regimens for ALL and LBL in AYAs and 1 meta-analysis favor the pediatric regimen. After more than a half-century of clinical trials of the pediatric regimens, including at least 160 phase 3 trials in the United States, the pediatric regimens have become far more complex than most adult regimens. Asparaginase, a critical component of the pediatric regimens, is more difficult to administer to AYAs (and older patients) but nonetheless has a favorable benefit to toxicity ratio for AYAs. A dramatic reduction in outcome of ALL and LBL during the AYA years (the "survival cliff") is coincident with similar reductions in proportions of AYAs referred to academic centers and enrolled on clinical trials (the "accrual cliff" and "referral cliff"). Conclusions and Relevance The accumulating data increasingly support treating AYAs with ALL and LBL with a pediatric-inspired regimen or an approved institutional or national clinical trial tailored for this patient group. A need to develop clinical trials specifically for AYAs and to encourage their participation is paramount, with a goal to improve both the quantity and quality of survival.
Collapse
Affiliation(s)
| | - Wendy Stock
- Alliance for Clinical Trials in Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Section of Hematology/Oncology, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Rebecca H Johnson
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,National Clinical Oncology Research Program (All in the National Cancer Institute National Clinical Trials Network).,Pediatric Hematology/Oncology, Mary Bridge Children's Hospital and Health Center and Tacoma General Hospital, Tacoma, Washington
| | - Anjali Advani
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Hematology/Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lori Muffly
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Blood and Marrow Transplantation, Department of Medicine, Stanford University, Palo Alto, California
| | - Dan Douer
- ECOG-ACRIN Cancer Research Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Keck Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles
| | - Damon Reed
- National Pediatric Cancer Foundation, Tampa, Florida.,Moffitt Cancer Center, Tampa, Florida
| | - Mark Lewis
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Hematology/Oncology, Intermountain Healthcare, Salt Lake City, Utah
| | - David R Freyer
- Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Keck Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles
| | - Bijal Shah
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Moffitt Cancer Center, Tampa, Florida.,National Comprehensive Cancer Network
| | - Selina Luger
- ECOG-ACRIN Cancer Research Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brandon Hayes-Lattin
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Radiation Medicine, Oregon Health and Science University, Portland
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, Portland.,NRG Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group), National Cancer Institute, Bethesda, Maryland
| | - Peter F Coccia
- Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,National Comprehensive Cancer Network.,Department of Pediatrics, University of Nebraska Medical Center, Omaha
| | - Daniel J DeAngelo
- Alliance for Clinical Trials in Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nita Seibel
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Archie Bleyer
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Radiation Medicine, Oregon Health and Science University, Portland
| |
Collapse
|
23
|
Approach to the Adult Acute Lymphoblastic Leukemia Patient. J Clin Med 2019; 8:jcm8081175. [PMID: 31390838 PMCID: PMC6722778 DOI: 10.3390/jcm8081175] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 02/06/2023] Open
Abstract
During recent decades, understanding of the molecular mechanisms of acute lymphoblastic leukemia (ALL) has improved considerably, resulting in better risk stratification of patients and increased survival rates. Age, white blood cell count (WBC), and specific genetic abnormalities are the most important factors that define risk groups for ALL. State-of-the-art diagnosis of ALL requires cytological and cytogenetical analyses, as well as flow cytometry and high-throughput sequencing assays. An important aspect in the diagnostic characterization of patients with ALL is the identification of the Philadelphia (Ph) chromosome, which warrants the addition of tyrosine kinase inhibitors (TKI) to the chemotherapy backbone. Data that support the benefit of hematopoietic stem cell transplantation (HSCT) in high risk patient subsets or in late relapse patients are still questioned and have yet to be determined conclusive. This article presents the newly published data in ALL workup and treatment, putting it into perspective for the attending physician in hematology and oncology.
Collapse
|
24
|
Myeloablative Unrelated Cord Blood Transplantation in Adolescents and Young Adults with Acute Leukemia. Biol Blood Marrow Transplant 2019; 25:2438-2446. [PMID: 31394275 DOI: 10.1016/j.bbmt.2019.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/09/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
Outcomes for adolescents and young adults (AYAs) with leukemia differ from other age groups and are still under-represented in clinical research. The aim of this study was to analyze outcomes of umbilical cord blood transplant (UCBT) in AYAs with acute leukemia reported to Eurocord/European Society for Blood and Marrow Transplantation. Patients (N = 504) had acute lymphoblastic (59%) or myeloid leukemia (41%), were aged 15 to 25 years, and received UCBT after myeloablative conditioning regimens between 2004 and 2016. The primary endpoint was 3-year overall survival (OS). Median follow-up was 3.9 years. Transplant was single in 58% and double UCBT in 42%. Three-year OS was 45% and leukemia free survival (LFS) was 41%. Cumulative incidence functions (CIFs) of nonrelapse mortality (NRM) and relapse were 31% and 28%, respectively. CIF of acute graft-versus-host disease (GVHD) grades II to IV at day 100 was 28%. Three-year CIF of chronic GVHD was 25%. In adjusted analysis, better disease status at UCBT (hazard ratio [HR], 2.74; P < .001) and more recent UCBT (HR, 1.43; P = .01) were associated with increased OS, and a similar effect of these factors was observed on LFS. Contrastingly, the use of antithymocyte globulin had a negative effect in LFS. The risk of acute GVHD grades II to IV increased with the use of double UCBT (HR, 1.65; P = .02) and decreased with more recent transplant period (HR, .65; P = .02) and antithymocyte globulin use (HR, .55; P = .01). Outcomes of AYA UCBT improved in more recent years, becoming comparable with pediatric results. Demonstrating the feasibility of UCBT in AYAs facilitates stem cell source selection and provides the basis for future prospective studies.
Collapse
|
25
|
Muffly L, Li Q, Alvarez E, Kahn J, Winestone L, Cress R, Penn DC, Keegan THM. Hematopoietic Cell Transplantation in Young Adult Acute Lymphoblastic Leukemia: A United States Population-Level Analysis. J Adolesc Young Adult Oncol 2019; 8:254-261. [PMID: 30657424 PMCID: PMC6588119 DOI: 10.1089/jayao.2018.0140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
In this population-based evaluation of adolescents and young adults (AYA) acute lymphoblastic leukemia (ALL), we describe patterns of care (POC) and outcomes regarding hematopoietic cell transplantation (HCT) in first complete remission (CR1). Data were abstracted from the 2013 United States Surveillance, Epidemiology, and End Results POC study; newly diagnosed AYA ALL were included. Multivariable logistic regression evaluated associations with HCT in CR1; Cox proportional hazards regression evaluated survival associations. Of 399 AYAs with ALL included, 102 (28.5%) underwent HCT in CR1. High-risk cytogenetics (odds ratio [OR] = 4.86, 95% confidence interval [CI] = 3.02-7.83) and hyper-cyclophosphamide, vincristine, adriamycin, and dexamethasone (CVAD) induction (OR = 1.84, 95% CI = 1.07-3.16) were associated with HCT in CR1. Two-year cumulative incidence of relapse, relapse-free survival (RFS), and overall survival (OS) of the entire cohort were 28.3% (95% CI = 23.4-33.4), 69.3% (95% CI = 63.6-74.3%), and 84.1% (95% CI = 79.7-87.5), respectively. Two-year RFS was significantly higher in patients receiving CR1 HCT relative to chemotherapy (83.6%, 95% CI = 72.6-90.5% vs. 64.3%, 95% CI = 57.5-70.3), but no difference was seen in 2-year OS (88.9%, 95% CI = 80.8-93.7 vs. 82.5%, 95% CI = 77.2-86.7). Treatment at a nonteaching hospital was independently associated with inferior OS (hazard ratio = 2.15, 95% CI = 1.23-3.76). Although the ALL landscape is changing, these data provide a snapshot of the use and outcomes of HCT for AYA ALL across the United States.
Collapse
Affiliation(s)
- Lori Muffly
- 1 Division of Blood and Marrow Transplantation, Stanford University, Stanford, California
| | - Qian Li
- 2 Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Elysia Alvarez
- 3 Division of Pediatric Hematology/Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Justine Kahn
- 4 Division of Pediatric Hematology/Oncology, Columbia University, New York, New York
| | - Lena Winestone
- 5 Division of Pediatric Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosemary Cress
- 6 Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, California
| | - Dolly C Penn
- 7 Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Theresa H M Keegan
- 2 Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
| |
Collapse
|
26
|
Hahn EE, Wu YL, Munoz-Plaza CE, Garcia Delgadillo J, Cooper RM, Chao CR. Use of recommended posttreatment services for adolescent and young adult survivors of Hodgkin lymphoma. Cancer 2019; 125:1558-1567. [PMID: 30620388 DOI: 10.1002/cncr.31953] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/16/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is a leading cancer diagnosis for adolescents and young adults (AYAs), with an overall 5-year survival rate of >80%. However, to the authors' knowledge, little is known regarding posttreatment patterns of care. In the current study, the authors characterized the use of guideline-recommended services in a cohort of AYA survivors of HL in Kaiser Permanente Southern California. METHODS Patients with HL who were diagnosed between ages 15 and 39 years between 2000 and 2010 were identified. The authors calculated the number of patients who received recommended short-term care within 2 years after treatment cessation for those who remained enrolled and alive from 2001 through 2015. Use of recommended late-effects screening for breast cancer and cardiovascular disease was examined. Logistic regression was used to evaluate the association between receipt of recommended care and patient, cancer, and treatment characteristics. RESULTS A total of 354 patients were identified, with a mean age at the time of diagnosis of 26 years (standard deviation, 6.9 years). Approximately 12% of patients had stage I disease, 59% had stage II disease, 17% had stage III disease, and 13% of patients had stage IV disease. Nearly all patients received chemotherapy (95%), 51% received radiotherapy, and 5% received care from a pediatric oncologist. Overall, approximately 49% of patients received recommended short-term care. Of those patients eligible for cardiovascular screening at 10 years posttreatment (60 patients), 53% received at least 1 screening. Of those patients eligible for breast cancer screening (21 patients), approximately 50% underwent at least 1 screening. Regression results indicated that those patients treated by a pediatric oncologist were >3 times as likely to receive recommended short-term care. CONCLUSIONS The results of the current study highlight gaps in the delivery of posttreatment care to AYA survivors of HL. By determining areas in need of improvement, these findings can guide the development of tailored interventions with which to improve care.
Collapse
Affiliation(s)
- Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yi-Lin Wu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Corrine E Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | | | - Robert M Cooper
- Southern California Permanente Medical Group, Los Angeles, California
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| |
Collapse
|
27
|
Gupta S, Pole JD, Baxter NN, Sutradhar R, Lau C, Nagamuthu C, Nathan PC. The effect of adopting pediatric protocols in adolescents and young adults with acute lymphoblastic leukemia in pediatric vs adult centers: An IMPACT Cohort study. Cancer Med 2019; 8:2095-2103. [PMID: 30912628 PMCID: PMC6536996 DOI: 10.1002/cam4.2096] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Retrospective studies have shown adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) have superior survival when treated in pediatric versus adult centers (locus of care; LOC). Several adult centers recently adopted pediatric protocols. Whether this has narrowed LOC disparities in real-world settings is unknown. METHODS The IMPACT Cohort is an Ontario population-based cohort that captured demographic, disease and treatment (treatment protocol, chemotherapy doses) data for all 15-21 year olds diagnosed with ALL 1992-2011. Cancer outcomes were determined by chart abstraction and linkage to provincial healthcare databases. Treatment protocols were classified as pediatric- or adult-based. We examined predictors of outcome, including LOC, protocol, disease biology, and time period. RESULTS Of 271 patients, 152 (56%) received therapy at adult centers. 5-year event-free survival (EFS ± SE) among AYA at pediatric vs adult centers was 72% ± 4% vs 56% ± 4% (P = 0.03); 5-year overall survival (OS) was 82% ± 4% vs 64% ± 4% (P < 0.001). After adjustment, OS remained inferior at adult centers (hazard ratio 2.5; 95% confidence interval 1.1-6.1; P = 0.04). In the most recent period (2006-2011), 39/59 (66%) AYA treated at adult centers received pediatric protocols. These AYA had outcomes superior to the 20 AYA treated on adult protocols, but inferior to the 44 AYA treated at pediatric centers (EFS 72% ± 5% vs 60% ± 9% vs 81% ± 6%; P = 0.02; OS 77% ± 7% vs 65% ± 11% vs 91% ± 4%; P = 0.004). Induction deaths and treatment-related mortality did not vary by LOC. CONCLUSIONS Survival disparities between AYA with ALL treated in pediatric vs adult centers have persisted over time, partially attributable to incomplete adoption of pediatric protocols by adult centers. Although pediatric protocol use has improved survival, residual disparities remain, perhaps due to other differences in care between adult and pediatric centers.
Collapse
Affiliation(s)
- Sumit Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
| | - Jason D Pole
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada.,Pediatric Oncology Group of Ontario, 480 University Ave, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of General Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cindy Lau
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Chenthila Nagamuthu
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Alvarez EM, Malogolowkin M, Li Q, Brunson A, Pollock BH, Muffly L, Wun T, Keegan THM. Decreased Early Mortality in Young Adult Patients With Acute Lymphoblastic Leukemia Treated at Specialized Cancer Centers in California. J Oncol Pract 2019; 15:e316-e327. [PMID: 30849003 DOI: 10.1200/jop.18.00264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Studies suggest that patients with acute lymphoblastic leukemia (ALL) have superior survival when treated at specialized cancer centers (SCCs). However, the association of early mortality (< 60 days) with location of initial care, sociodemographic factors, and complications has not been evaluated in pediatric and young adult (YA) patients with ALL. METHODS Using the California Cancer Registry linked to hospitalization data, we identified pediatric and YA patients with ALL who received inpatient leukemia treatment between 1991 and 2014. Patients were classified as receiving all or part/none of their care at an SCC (Children's Oncology Group- or National Cancer Institute-designated cancer center). Propensity scores were created for treatment at an SCC in each age group. Multivariable, inverse probability-weighted Cox proportional hazards regression models identified factors associated with early mortality. Results are presented as hazard ratios (HRs) and 95% CIs. RESULTS Among 6,531 newly diagnosed pediatric (≤ 18 years) and YA (19 to 39 years of age) patients with ALL, 1.6% of children and 5.4% of YAs died within 60 days of diagnosis. Most children received all of their care at an SCC (n = 4,752; 85.7%) compared with 35.5% of YAs (n = 1,779). Early mortality rates were lower in pediatric patients and those receiving all care at an SCC (pediatric: all, 1.5%, v part/none, 2.4%; P = .049; YAs: all, 3.2%, v part/none, 6.6%; P = .001). However, in adjusted models, receiving all care at an SCC was associated with significantly lower early mortality in YAs (HR, 0.51; 95% CI, 0.32 to 0.81), but not in pediatric patients (HR, 0.77; 95% CI, 0.47 to 1.25). CONCLUSION YAs with ALL experience significant reductions in early mortality after treatment at SCCs.
Collapse
Affiliation(s)
| | | | - Qian Li
- 1 University of California, Davis, CA
| | | | | | | | - Ted Wun
- 1 University of California, Davis, CA
| | | |
Collapse
|
29
|
Validity of Administrative Data in Identifying Cancer-related Events in Adolescents and Young Adults: A Population-based Study Using the IMPACT Cohort. Med Care 2019; 56:e32-e38. [PMID: 28731893 DOI: 10.1097/mlr.0000000000000777] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults with cancer. METHODS We identified all Ontario adolescents and young adults 15-21 years old diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992-2012. Chart abstraction determined the end of initial treatment (EOIT) date and subsequent cancer-related events (progression, relapse, second cancer). Linkage to population-based administrative databases identified fee and procedure codes indicating cancer treatment or palliative care. Algorithms determining EOIT based on a time interval free of treatment-associated codes, and new cancer-related events based on billing codes, were compared with chart-abstracted data. RESULTS The cohort comprised 1404 patients. Time periods free of treatment-associated codes did not validly identify EOIT dates; using subsequent codes to identify new cancer events was thus associated with low sensitivity (56.2%). However, using administrative data codes that occurred after the EOIT date based on chart abstraction, the first cancer-related event was identified with excellent validity (sensitivity, 87.0%; specificity, 93.3%; positive predictive value, 81.5%; negative predictive value, 95.5%). CONCLUSIONS Although administrative data alone did not validly identify cancer-related events, administrative data in combination with chart collected EOIT dates was associated with excellent validity. The collection of EOIT dates by cancer registries would significantly expand the potential of administrative data linkage to assess cancer outcomes.
Collapse
|
30
|
White VM, Skaczkowski G, Pinkerton R, Coory M, Osborn M, Bibby H, Nicholls W, Orme LM, Conyers R, Phillips MB, Harrup R, Walker R, Thompson K, Anazodo A. Clinical management of Australian adolescents and young adults with acute lymphoblastic and myeloid leukemias: A national population-based study. Pediatr Blood Cancer 2018; 65:e27349. [PMID: 30039912 DOI: 10.1002/pbc.27349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND While several studies have examined the treatment of adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL), studies of acute myeloid leukemia (AML) are rare. Using national data for Australia, we describe (i) the number and type of treatment centers caring for AYAs, (ii) induction/first-line treatments, and (iii) survival outcomes. PROCEDURE National population-based study assessing treatment of 15- to 24-year-olds diagnosed with ALL or AML between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult (adult AYA-focused or other adult; and by AYA volume [high/low]). Cox proportional hazard regression analyses examined associations between treatment and overall, event-free, and relapse-free survival outcomes. RESULTS Forty-seven hospitals delivered induction therapy to 351 patients (181 ALL and 170 AML), with 74 (21%) treated at pediatric centers; 70% of hospitals treated less than two AYA leukemia patients per year. Regardless of treatment center, 82% of ALL patients were on pediatric protocols. For AML, pediatric protocols were not used in adult centers, with adult centers using a non-COG 7+3-type induction protocol (51%, where COG is Cooperative Oncology Group) or an ICE-type protocol (39%, where ICE is idarubicin, cytarabine, etoposide). Exploratory analyses suggested that for both ALL and AML, AYAs selected for adult protocols have worse overall, event-free, and relapse-free survival outcomes. CONCLUSIONS Pediatric protocols were commonly used for ALL patients regardless of where they are treated, indicating rapid assimilation of recent evidence by Australian hematologists. For AML, pediatric protocols were only used at pediatric centers. Further investigation is warranted to determine the optimal treatment approach for AYA AML patients.
Collapse
Affiliation(s)
- V M White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - G Skaczkowski
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - R Pinkerton
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - M Coory
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - M Osborn
- Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - H Bibby
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - W Nicholls
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - L M Orme
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - R Conyers
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M B Phillips
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - R Harrup
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - R Walker
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - K Thompson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| |
Collapse
|
31
|
Bleyer A, Tai E, Siegel S. Role of clinical trials in survival progress of American adolescents and young adults with cancer-and lack thereof. Pediatr Blood Cancer 2018; 65:e27074. [PMID: 29667766 PMCID: PMC6077840 DOI: 10.1002/pbc.27074] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
In the United States, adolescent and young adult (AYA) patients with cancer have the lowest clinical trial participation rate of all age groups and slower progress in survival improvement than younger patients. Ominously, AYA clinical trial participation has been steadily decreasing since 2010, except in 15-19 year olds and AYAs with acute lymphoblastic leukemia. In order to reverse the accrual trend, multiple changes are necessary, including convincing community oncologists to pursue clinical trials on behalf of their AYA patients and to have the new National Community Oncology Research Program and National Clinical Trials Network lead a coordinated effort to increase accrual.
Collapse
Affiliation(s)
- Archie Bleyer
- Oregon Health&Science University
- University of Texas Medical School at Houston
| | - Eric Tai
- Centers for Disease Control and Prevention
| | | |
Collapse
|
32
|
Spraker-Perlman H, Smits-Seeman RR, Li H, Kirchhoff AC. Statewide Treatment Center Referral Patterns for Adolescent and Young Adult Patients with Cancer in Utah. J Adolesc Young Adult Oncol 2018; 7:688-691. [PMID: 30036101 DOI: 10.1089/jayao.2018.0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer therapy is selected by individual oncology providers. For adolescent and young adults (AYAs), the type of provider, adult or pediatric, and medical facility type, non- or academic, influence regimens offered. We evaluated the proportions of 15-29-year-old cancer patients in Utah seen at pediatric and adult academic centers between 1994 and 2013 and examined factors that influence treatment location. Of all AYA patients, 31.6% were treated in academic centers and those with sarcomas, central nervous system tumors, and leukemias were more likely to be treated at academic centers. Further determinants of AYA healthcare access and cooperation between adult and pediatric providers are needed.
Collapse
Affiliation(s)
- Holly Spraker-Perlman
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rochelle R Smits-Seeman
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Hongyan Li
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| |
Collapse
|
33
|
Muffly L, Alvarez E, Lichtensztajn D, Abrahão R, Gomez SL, Keegan T. Patterns of care and outcomes in adolescent and young adult acute lymphoblastic leukemia: a population-based study. Blood Adv 2018; 2:895-903. [PMID: 29669756 PMCID: PMC5916002 DOI: 10.1182/bloodadvances.2017014944] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/13/2018] [Indexed: 01/07/2023] Open
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.
Collapse
Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Stanford, CA
| | - Elysia Alvarez
- Division of Hematology/Oncology, Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA
| | | | | | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; and
| | - Theresa Keegan
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA
| |
Collapse
|
34
|
Recent Developments in Adolescent and Young Adult (AYA) Acute Lymphoblastic Leukemia. Curr Hematol Malig Rep 2018; 13:100-108. [DOI: 10.1007/s11899-018-0442-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Fidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study. Lancet Oncol 2017; 18:1579-1589. [PMID: 29111259 DOI: 10.1016/s1470-2045(17)30677-0] [Citation(s) in RCA: 345] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND To date, the burden of cancer among young adults has rarely been studied in depth. Our aim was to describe the scale and profile of cancer incidence and mortality worldwide among 20-39 year-olds, highlighting major patterns by age, sex, development level, and geographical region. METHODS We did a population-based study to quantify the burden of young adult cancers worldwide. We defined young adult cancers as those occurring between the ages of 20 and 39 years because these individuals will have passed puberty and adolescence, but not yet experienced the effects of hormonal decline, immune response deterioration, or organ dysfunction associated with chronic health conditions. Global, regional, and country-specific (n=184) data estimates of the number of new cancer cases and cancer-associated deaths that occurred in 2012 among young adults were extracted in four 5-year bands from the International Agency for Research on Cancer's GLOBOCAN 2012 for all cancers combined and for 27 major types as defined by the International Classification of Disease, tenth revision. We report the number of new cancer cases and cancer-associated deaths overall and by sex alongside corresponding age-standardised rates (ASR) per 100 000 people per year. We also present results using four levels of the Human Development Index (HDI; low [least developed], medium, high, and very high [most developed]), which is a composite indicator for socioeconomic development comprising life expectancy, education, and gross national income. FINDINGS 975 396 new cancer cases and 358 392 cancer-associated deaths occurred among young adults worldwide in 2012, which equated to an ASR of 43·3 new cancer cases per 100 000 people per year and 15·9 cancer-associated deaths per 100 000 people per year. The burden was disproportionally greater among women and the most common cancer types overall in terms of new cases were female breast cancer, cervical cancer, thyroid cancer, leukaemia, and colorectal cancer; in terms of deaths, female breast cancer, liver cancer, leukaemia, and cervical cancer were the main contributors. When assessed by development level and geographical region, the cancer profile varied substantially; generally, the burden of infection-associated cancers was greater in regions under transition. Cancer incidence was elevated in very high-HDI regions compared with low-HDI regions (ASR 64·5 vs 46·2 cancer cases per 100 000 people per year); however, the mortality burden was 3 times higher in low-HDI regions (ASR 25·4 vs 9·2 cancer-associated deaths per 100 000 people per year), reflecting differences in cancer profiles and inferior outcomes. INTERPRETATION The global cancer burden among 20-39 year-olds differs from that seen in younger or older ages and varies substantially by age, sex, development level, and geographical region. Although the cancer burden is lower in this age group than that observed in older ages, the societal and economic effects remain great given the major effects of premature morbidity and mortality. Targeted surveillance, prevention, and treatment are needed to reduce the cancer burden in this underserved age group. FUNDING International Agency for Research on Cancer (IARC) and European Commission's FP-7 Marie Curie Actions-People-COFUND.
Collapse
Affiliation(s)
- Miranda M Fidler
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Sumit Gupta
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
36
|
Jaffee EM, Dang CV, Agus DB, Alexander BM, Anderson KC, Ashworth A, Barker AD, Bastani R, Bhatia S, Bluestone JA, Brawley O, Butte AJ, Coit DG, Davidson NE, Davis M, DePinho RA, Diasio RB, Draetta G, Frazier AL, Futreal A, Gambhir SS, Ganz PA, Garraway L, Gerson S, Gupta S, Heath J, Hoffman RI, Hudis C, Hughes-Halbert C, Ibrahim R, Jadvar H, Kavanagh B, Kittles R, Le QT, Lippman SM, Mankoff D, Mardis ER, Mayer DK, McMasters K, Meropol NJ, Mitchell B, Naredi P, Ornish D, Pawlik TM, Peppercorn J, Pomper MG, Raghavan D, Ritchie C, Schwarz SW, Sullivan R, Wahl R, Wolchok JD, Wong SL, Yung A. Future cancer research priorities in the USA: a Lancet Oncology Commission. Lancet Oncol 2017; 18:e653-e706. [PMID: 29208398 PMCID: PMC6178838 DOI: 10.1016/s1470-2045(17)30698-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022]
Abstract
We are in the midst of a technological revolution that is providing new insights into human biology and cancer. In this era of big data, we are amassing large amounts of information that is transforming how we approach cancer treatment and prevention. Enactment of the Cancer Moonshot within the 21st Century Cures Act in the USA arrived at a propitious moment in the advancement of knowledge, providing nearly US$2 billion of funding for cancer research and precision medicine. In 2016, the Blue Ribbon Panel (BRP) set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment. Those recommendations provided a high-level view of how to accelerate the conversion of new scientific discoveries into effective treatments and prevention for cancer. The US National Cancer Institute is already implementing some of those recommendations. As experts in the priority areas identified by the BRP, we bolster those recommendations to implement this important scientific roadmap. In this Commission, we examine the BRP recommendations in greater detail and expand the discussion to include additional priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. We prioritise areas of research in the USA that we believe would accelerate efforts to benefit patients with cancer. Finally, we hope the recommendations in this report will facilitate new international collaborations to further enhance global efforts in cancer control.
Collapse
Affiliation(s)
| | - Chi Van Dang
- Ludwig Institute for Cancer Research New York, NY; Wistar Institute, Philadelphia, PA, USA.
| | - David B Agus
- University of Southern California, Beverly Hills, CA, USA
| | - Brian M Alexander
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Alan Ashworth
- University of California San Francisco, San Francisco, CA, USA
| | | | - Roshan Bastani
- Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Sangeeta Bhatia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeffrey A Bluestone
- University of California San Francisco, San Francisco, CA, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | | | - Atul J Butte
- University of California San Francisco, San Francisco, CA, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nancy E Davidson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Mark Davis
- California Institute for Technology, Pasadena, CA, USA
| | | | | | - Giulio Draetta
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Lindsay Frazier
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Patricia A Ganz
- Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Levi Garraway
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; The Broad Institute, Cambridge, MA, USA; Eli Lilly and Company, Boston, MA, USA
| | | | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Faculty of Medicine and IHPME, University of Toronto, Toronto, Canada
| | - James Heath
- California Institute for Technology, Pasadena, CA, USA
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cliff Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Chanita Hughes-Halbert
- Medical University of South Carolina and the Hollings Cancer Center, Charleston, SC, USA
| | - Ramy Ibrahim
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Hossein Jadvar
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | - Rick Kittles
- College of Medicine, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Scott M Lippman
- University of California San Diego Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - David Mankoff
- Department of Radiology and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elaine R Mardis
- The Institute for Genomic Medicine at Nationwide Children's Hospital Columbus, OH, USA; College of Medicine, Ohio State University, Columbus, OH, USA
| | - Deborah K Mayer
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Kelly McMasters
- The Hiram C Polk Jr MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | | | | | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dean Ornish
- University of California San Francisco, San Francisco, CA, USA
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | | | - Martin G Pomper
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek Raghavan
- Levine Cancer Institute, Carolinas HealthCare, Charlotte, NC, USA
| | | | - Sally W Schwarz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Richard Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Jedd D Wolchok
- Ludwig Center for Cancer Immunotherapy, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Sandra L Wong
- Department of Surgery, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alfred Yung
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|