Journal article
Guideline-concordant treatment among adolescents and young adults with acute lymphoblastic leukemia
JNCI cancer spectrum, Vol.9(3), pkaf033
04/30/2025
DOI: 10.1093/jncics/pkaf033
PMCID: PMC12121638
PMID: 40238217
Abstract
Individuals diagnosed with acute lymphoblastic leukemia (ALL) between 15-39yo (AYA: adolescents and young adults) face poor survival and unique challenges. We evaluated facility-level factors and guideline-concordant care (GCC) among AYAs with ALL at National Cancer Institute Community Oncology Research Program (NCORP) practices.
We assembled a retrospective cohort of 15-39yo AYAs with ALL treated at participating NCORPs between 2012-2016. NCORPs abstracted patient data and completed facility-level questionnaires for each clinical facility (CF: study-defined criteria). The central review committee adjudicated whether treatment was concordant with AYA-specific National Comprehensive Cancer Network ALL guidelines (ie, pediatric-inspired therapy or clinical trial). GCC was described by age, facility model (adult/internal medicine [adult/IM], pediatric, mixed [pediatric services within a general hospital]), and average annual AYA ALL volume. Generalized linear mixed effects models estimated the odds of GCC.
AYAs receiving GCC were younger (n = 196, median = 19.5y) than those who did not (n = 31, median = 32.1y). GCC was observed in many 22-39yo (68.8%), and nearly universal in 15-21 y. In multivariable analyses, AYAs at adult/IM CFs had lower odds of GCC (OR = 0.02, 95% CI, 0.0-0.18); there was no statistically significant association between annual AYA ALL volume and receiving GCC. GCC was observed more often in adult/IM and/or mixed CFs with communication between adult/pediatric counterparts, AYA ALL Clinical Pathways, and/or AYA-specific meetings.
GCC among AYAs with ALL (specifically pediatric-inspired therapy) at NCORPs is associated with facility model (adult/IM), but not AYA ALL volume. Strategies to improve GCC could include facilitating communication and clinical pathways at adult/IM CFs treating AYA ALL.
Details
- Title: Subtitle
- Guideline-concordant treatment among adolescents and young adults with acute lymphoblastic leukemia
- Creators
- Julie A Wolfson - University of Alabama at BirminghamAllison C Grimes - Division of Pediatric Hematology-Oncology, University of Texas Health Science Center San Antonio, San Antonio, TX, USAMichelle M Nuño - Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USASubhash Ramakrishnan - Children's Oncology Group, Monrovia, CA, USADavid S Dickens - University of IowaMichael E Roth - Division of Pediatric Oncology, MD Anderson Cancer Center, Houston, TX, USAWendy Woods - Blank Children's HospitalKandice S Adams - University of Alabama at BirminghamTawa Alabi - University of Alabama at BirminghamMelissa Beauchemin - Columbia University Irving Medical CenterJennifer M Levine - Center for Cancer and Blood DisordersMichele Scialla - Division of Pediatric Hematology-Oncology, Nemours Children's Hospital, Wlimington, DE, USAKoh B Boayue - UNM Comprehensive Cancer CenterCharlotte L Kerber - University of California, DavisOlivia Ponce - Children's Oncology Group, Monrovia, CA, USASarah Vargas - Children's Oncology Group, Monrovia, CA, USAGeorge J Chang - The University of Texas MD Anderson Cancer CenterWendy Stock - University of ChicagoDawn Hershman - Columbia UniversityEmily Curran - University of CincinnatiAnjali Advani - Cleveland ClinicKristen O'Dwyer - University of RochesterSelina Luger - University of PennsylvaniaJane Jijun Liu - Illinois CancerCareDavid R Freyer - Children's Hospital of Los AngelesLillian Sung - Hospital for Sick ChildrenSusan K Parsons - Tufts Medical Center
- Resource Type
- Journal article
- Publication Details
- JNCI cancer spectrum, Vol.9(3), pkaf033
- DOI
- 10.1093/jncics/pkaf033
- PMID
- 40238217
- PMCID
- PMC12121638
- NLM abbreviation
- JNCI Cancer Spectr
- ISSN
- 2515-5091
- eISSN
- 2515-5091
- Publisher
- OXFORD UNIV PRESS
- Grant note
- Children's Oncology GroupNCORP research bases,ECOG-ACRIN Leukemia Committee
The authors would like to acknowledge the efforts of all of the participating NCORP sites and staff whose work contributed significantly to the project presented above. The authors are especially grateful to Ha Dang and Tammy Lo for their contributions to the conduct of this analysis. This work would not have been possible without the collaboration of the following groups from the noted NCORP research bases, as represented by the identified co-authors: Alliance Cancer Care Delivery Research (G. Chang) and Leukemia (W. Stock, E. Curran) committees along with the Alliance Community Oncology Co-PI (J. Liu), SWOG Cancer Care Delivery (D. Hershman), and Leukemia (A. Advani, K. O'Dwyer) committees, and ECOG-ACRIN Leukemia Committee (S. Luger).
- Language
- English
- Electronic publication date
- 04/16/2025
- Date published
- 04/30/2025
- Academic Unit
- Stead Family Department of Pediatrics; Hematology/Oncology
- Record Identifier
- 9984811211602771
Metrics
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