Younger Patients With Leukemia Benefit From Pediatric Cancer Center Visits

04/22/18

Referral of newly diagnosed adolescent patients with acute lymphoblastic leukemia (ALL) to pediatric and National Cancer Institute (NCI)-designated centers should be strongly recommended, according to a study published in Blood Advances (online April 18, 2018; doi:10.1182/bloodadvances.2017014944).

The study found that treatment at NCI-affiliated center improves overall survival (OS) in this population.

Prior research has suggested that adolescents and young adults with ALL benefit from better outcomes when treated with pediatric protocols, which are not commonly used in adult cancer centers.

Lori Muffly, MD, department of medicine, Stanford University, and colleagues conducted a study to provide a real-world understanding of the site of care and front-line regimens administered to newly diagnosed adolescents and young adults with ALL. Researchers sampled California Cancer Registry data of 1473 patients aged 15-39 years with newly diagnosed disease from 2004-2014. Researchers then stratified patients by center of care (pediatric or adult)—acknowledging whether the facility was affiliated with the NCI—and evaluated OS based on treatment setting.

Thirty-two percent (n = 475) of the patients received care in a pediatric setting, 89% of whom (n = 422) received front-line ALL therapy at NCI-designated cancer settings. Among the remaining 68% (n = 998) of patients treated in an adult setting, only 28% (n = 406) received care in an NCI-designated center.

Dr Muffly and colleagues found that treatment in a pediatric setting was independently associated with a significantly higher OS compared with treatment in an adult setting (HR, 0.53). A similar trend was observed for treatment in an NCI-designated center (HR, 0.80).

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"Physicians and treatment teams in pediatric and NCI-designated cancer settings may be more experienced in caring for ALL in adolescents and young adults, and this may in part may explain why we are seeing better outcomes in these centers," noted Dr Muffly in a statement (April 18, 2018).

Given the potential survival benefits, front-line treatment of adolescents and young adults with ALL at pediatric and/or NCI-designated centers should be considered, researchers concluded.—Zachary Bessette