Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome

Adolescents and young adults (AYA; 15-39 years) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared with children. Impact of care at NCI-designated Comprehensive Cancer Centers (CCC) or Children's Oncology Group sites (COG) on surv...

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Bibliographic Details
Published in:Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2017-03, Vol.26 (3), p.312-320
Main Authors: Wolfson, Julie, Sun, Can-Lan, Wyatt, Laura, Stock, Wendy, Bhatia, Smita
Format: Article
Language:English
Subjects:
Acute lymphoblastic leukemia
Acute myeloid leukemia
Adolescent
Adolescents
Adult
Age Factors
Cancer
Cancer Care Facilities - statistics & numerical data
Children
Cohort Studies
Female
Health Services Accessibility - statistics & numerical data
Humans
Leukemia
Leukemia, Myeloid, Acute - mortality
Los Angeles - epidemiology
Lymphatic leukemia
Male
Minority & ethnic groups
Myeloid leukemia
Population Surveillance
Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality
Proportional Hazards Models
Registries
Risk Factors
Survival
Young Adult
Young adults
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Summary:Adolescents and young adults (AYA; 15-39 years) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared with children. Impact of care at NCI-designated Comprehensive Cancer Centers (CCC) or Children's Oncology Group sites (COG) on survival disparities remains unstudied. Using the Los Angeles cancer registry, we identified 1,870 ALL or AML patients between 1 and 39 years at diagnosis. Cox regression analyses assessed risk of mortality; younger age + CCC/COG served as the referent group. Logistic regression was used to determine odds of care at CCC/COG, adjusting for variables above. ALL outcome: AYAs at non-CCC/COG experienced inferior survival (15-21 years: HR = 1.9, = 0.005; 22-29 years: HR = 2.6, < 0.001; 30-39 years: HR = 3.0, < 0.001). Outcome at CCC/COG was comparable between children and young AYAs (15-21 years: HR = 1.3, = 0.3; 22-29 years: HR = 1.2, = 0.2) but was inferior for 30- to 39-year-olds (HR = 3.4, < 0.001). AML outcome: AYAs at non-CCC/COG experienced inferior outcome (15-21 years: HR = 1.8, = 0.02; 22-39 years: HR = 1.4, = 0.06). Outcome at CCC/COG was comparable between children and 15- to 21-year-olds (HR = 1.3, = 0.4) but was inferior for 22- to 39-year-olds (HR = 1.7, = 0.05). Access: 15- to 21-year-olds were less likely to use CCC/COG than children ( < 0.001). In 22- to 39-year-olds, public/uninsured (ALL: = 0.004; AML
ISSN:1055-9965
1538-7755
DOI:10.1158/1055-9965.EPI-16-0722