Guideline-concordant treatment among adolescents and young adults with acute lymphoblastic leukemia
Menée aux Etats-Unis à partir de données portant sur 196 adolescents ou jeunes adultes atteints d'une leucémie lymphoblastique aiguë (LLA) traitée entre 2012 et 2016, cette étude examine la concordance entre les recommandations et les traitements reçus puis analyse l'association entre cette concordance et le nombre annuel d'adolescents et jeunes adultes traités pour une LLA
Background : 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.
Methods : We assembled a retrospective cohort of 15-39 yo 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.
Results : 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.
Conclusion : 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.
JNCI Cancer Spectrum , article en libre accès 2025