Causes of Inferior Outcome in Adolescents and Young Adults with Acute Lymphoblastic Leukemia: Across Oncology Services and Regardless of Clinical Trial Enrollment

Adolescents and young adults (AYA: 15-39 years) with acute lymphoblastic leukemia (ALL) have inferior survival when compared with children (1-14 years). An approach is lacking that includes both patients enrolled and not enrolled in clinical trials, and includes the contribution of health care deliv...

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Veröffentlicht in:Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2018-10, Vol.27 (10), p.1133-1141
Hauptverfasser: Wolfson, Julie A, Richman, Joshua S, Sun, Can-Lan, Landier, Wendy, Leung, Karen, Smith, Eileen P, O'Donnell, Margaret, Bhatia, Smita
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container_end_page 1141
container_issue 10
container_start_page 1133
container_title Cancer epidemiology, biomarkers & prevention
container_volume 27
creator Wolfson, Julie A
Richman, Joshua S
Sun, Can-Lan
Landier, Wendy
Leung, Karen
Smith, Eileen P
O'Donnell, Margaret
Bhatia, Smita
description Adolescents and young adults (AYA: 15-39 years) with acute lymphoblastic leukemia (ALL) have inferior survival when compared with children (1-14 years). An approach is lacking that includes both patients enrolled and not enrolled in clinical trials, and includes the contribution of health care delivery, treatment, and clinical prognosticators. We assembled a retrospective cohort of ALL patients diagnosed between 1-39 years (AYA: = 93; child: = 91) and treated at a single institution between 1990 and 2010, irrespective of clinical trial enrollment. We modeled relapse risk (i) during therapy and (ii) after completing therapy. On-therapy relapse: AYA experienced an increased risk of on-therapy relapse versus children (HR, 10.5; = 0.004). In multivariable analysis restricted to AYA, independent predictors of relapse included lack of clinical trial enrollment (HR, 2.6, = 0.04) and nonwhite race/ethnicity (HR, 2.2; = 0.05). Relapse after completing therapy: When compared with children, AYA experienced an increased risk of relapse after completing therapy (HR, 7.7; < 0.001). In multivariable analysis restricted to AYA, longer therapy (months of maintenance: HR, 0.7; < 0.001; months of consolidation: HR, 0.8; = 0.03) protected against relapse. Among AYA, aspects of health care delivery (clinical trial enrollment, nonwhite race/ethnicity) are associated with relapse during therapy, and aspects of treatment (shorter duration of maintenance and consolidation) are associated with relapse after completing therapy. These findings highlight the importance of clinical trial enrollment and therapy duration (maintenance, consolidation) in ensuring durable remissions in AYA ALL. Future studies encompassing health care delivery, treatment, and biology are needed. .
doi_str_mv 10.1158/1055-9965.EPI-18-0430
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In multivariable analysis restricted to AYA, longer therapy (months of maintenance: HR, 0.7; &lt; 0.001; months of consolidation: HR, 0.8; = 0.03) protected against relapse. Among AYA, aspects of health care delivery (clinical trial enrollment, nonwhite race/ethnicity) are associated with relapse during therapy, and aspects of treatment (shorter duration of maintenance and consolidation) are associated with relapse after completing therapy. These findings highlight the importance of clinical trial enrollment and therapy duration (maintenance, consolidation) in ensuring durable remissions in AYA ALL. 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title Causes of Inferior Outcome in Adolescents and Young Adults with Acute Lymphoblastic Leukemia: Across Oncology Services and Regardless of Clinical Trial Enrollment
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