Adoption of pediatric-inspired acute lymphoblastic leukemia regimens by adult oncologists treating adolescents and young adults: A population-based study.
BACKGROUND
Studies have demonstrated superior outcomes for adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) who are treated using pediatric versus adult therapeutic regimens. To the best of our knowledge, whether adult oncologists in the United States have adopted this approach to ALL in AYA patients is currently unknown. The objective of the current study was to provide a population-based description of ALL treatment patterns in AYA individuals over the past decade.


METHODS
Data regarding AYA patients aged 15 to 39 years and diagnosed with ALL between 2004 and 2014 while living in the Greater Bay Area were obtained from the Greater Bay Area Cancer Registry (GBACR). Treating facilities were designated as pediatric or adult centers; induction treatment regimens were abstracted from registry text data fields.


RESULTS
Of 304 patients diagnosed in the GBACR catchment region, complete treatment data were available for 229 (75%). The location of care was identified for 296 patients (97%) treated at 31 unique centers. Approximately 70% of AYA patients received induction therapy at an adult treatment center. All AYA patients who were treated at pediatric centers received pediatric ALL regimens. Among AYA patients treated by adult oncologists with complete treatment data, none received a pediatric regimen before 2008. Between 2008 and 2012, while the US Adult Intergroup C10403 pediatric-inspired ALL protocol was open to accrual, 31% of AYA patients treated by adult oncologists received pediatric regimens. This rate fell to 21% from 2013 through 2014. Adult facilities treating ≥ 2 AYA patients with ALL per year captured in the GBACR were more likely to administer pediatric regimens than lower volume centers (P = .03).


CONCLUSIONS
As of 2014, only a minority of AYA patients with ALL received pediatric ALL regimens at adult cancer centers. Cancer 2017;122-130. © 2016 American Cancer Society.
Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Stanford, California.|Stanford Cancer Institute, Stanford University, Stanford, California.
Lori
L
Muffly
Cancer Prevention Institute of California, Freemont, California.
Daphne
D
Lichtensztajn
Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Stanford, California.
Parveen
P
Shiraz
Cancer Prevention Institute of California, Freemont, California.
Renata
R
Abrahão
Section of Hematology/Oncology, Department of Pediatrics, University of Chicago, Chicago, Illinois.
Jennifer
J
McNeer
Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.
Wendy
W
Stock
Division of Hematology and Oncology, Department of Medicine, University of California at Davis School of Medicine, Sacramento, California.
Theresa
T
Keegan
Stanford Cancer Institute, Stanford University, Stanford, California.|Cancer Prevention Institute of California, Freemont, California.
Scarlett Lin
SL
Gomez
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D000072103:Oncologists; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D014481:United States; D055815:Young Adult
D000970:Antineoplastic Agents
acute lymphoblastic leukemia; adolescent and young adult; clinical practice; epidemiology; practice patterns