Pediatric Centers May Improve Survival for Adolescents and Young Adults With ALL

Key Points

  • 475 (32%) of 1,473 AYA patients with ALL received care in a pediatric setting; 422 (89%) of these patients received front-line ALL therapy at NCI-designated cancer centers.
  • Treatment in a pediatric setting was independently associated with a significantly higher overall survival compared to treatment in an adult setting, as was treatment in an NCI-designated center.

Adolescents and young adults (AYAs) with acute lymphocytic leukemia (ALL) have a survival advantage if they receive treatment at a pediatric cancer center vs an adult center, according to a study published by Muffly et al in Blood Advances. The findings also suggest that treatment at a center affiliated with the National Cancer Institute (NCI) improves overall survival. 

Evidence suggests that AYAs with ALL fare better when treated with pediatric protocols, which are not uniformly used in adult cancer centers. This study was designed to provide a real-world understanding of the location of care and front-line regimens administered to newly diagnosed AYAs with ALL. 

Study Methods

Researchers reviewed California Cancer Registry data from 2004–2014 and identified 1,473 newly diagnosed ALL patients aged 15–39 years. They then designated the patients’ center of care as either pediatric or adult, noting whether the facility was affiliated with the NCI, and assessed overall survival based on treatment setting. 

Study Findings

Four hundred and seventy-five (32%) of 1,473 AYA patients with ALL received care in a pediatric setting; 422 (89%) of these patients received front-line ALL therapy at NCI-designated cancer centers. Among the 998 patients treated in an adult setting, only 406 (28%) received care in an NCI-designated center. Treatment in a pediatric setting was independently associated with a significantly higher overall survival compared to treatment in an adult setting (hazard ratio = 0.53), as was treatment in an NCI-designated center (hazard ratio = 0.80).

“Physicians and treatment teams in pediatric and NCI-designated cancer settings may be more experienced in caring for acute lymphocytic leukemia in adolescents and young adults, and this in part may explain why we are seeing better outcomes in these centers,” said lead author Lori Muffly, MD, of Stanford University Department of Medicine

The study authors noted that ALL treatment guidelines were updated in recent years to recommend the treatment of AYA patients with pediatric protocols. Although the authors found that only a minority of AYAs treated in adult cancer centers received these types of protocols during the time period studied, survival of AYA patients with ALL treated in adult cancer centers is expected to improve as more adult cancer centers update their practice to use these protocols since the 2014 data cutoff. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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