For Young Adults with Blood Cancer, Pediatric Centers May Improve Survival
Published on: April 17, 2018
April 18, 2018) — Adolescents and young adults with acute leukemia have a
survival advantage if they receive treatment at a pediatric cancer center versus
an adult center, according
to a new study.
study, published online today in Blood Advances, a journal of the
American Society of Hematology, also suggests that treatment at a center
affiliated with the National Cancer Institute (NCI) improves overall survival.
Background: Evidence suggests
that adolescents and young adults (AYA) with acute lymphocytic leukemia (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 ages 15–39. 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.
Results: 475 of 1,473 (32%)
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=.53), as was treatment in an NCI-designated center
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.
authors note 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.
Conclusion: This study suggests
that referral of newly diagnosed AYA patients with ALL to pediatric and
NCI-designated centers should be strongly considered.
Additional Notes: Findings from this
study were presented during an oral presentation at the 59th
American Society of Hematology Annual Meeting in Atlanta.
Blood Advances, is
a peer-reviewed, online only, open access journal of the American Society
of Hematology (ASH), the
world’s largest professional society concerned with the causes and treatment of
ASH’s mission is
to further the understanding, diagnosis, treatment, and prevention of disorders
affecting blood, bone marrow, and the immunologic, hemostatic, and vascular
systems by promoting research, clinical care, education, training, and advocacy
Blood Advances® is
a registered trademark of the American Society of Hematology.
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Fitzmaurice, American Society of Hematology