Austin Health

Title
Clinical management of Australian adolescents and young adults with acute lymphoblastic and myeloid leukemias: A national population-based study.
Publication Date
2018-11
Author(s)
White, V M
Skaczkowski, Gemma
Pinkerton, R
Coory, M
Osborn, M
Bibby, H
Nicholls, W
Orme, L M
Conyers, R
Phillips, M B
Harrup, R
Walker, R
Thompson, K
Anazodo, A
Subject
ALL
AML
adolescents and young adults
population-based study
survival
treatment
Type of document
Journal Article
OrcId
0000-0001-6619-8484
0000-0003-0715-3563
0000-0002-2344-1365
DOI
10.1002/pbc.27349
Abstract
While several studies have examined the treatment of adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL), studies of acute myeloid leukemia (AML) are rare. Using national data for Australia, we describe (i) the number and type of treatment centers caring for AYAs, (ii) induction/first-line treatments, and (iii) survival outcomes. National population-based study assessing treatment of 15- to 24-year-olds diagnosed with ALL or AML between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult (adult AYA-focused or other adult; and by AYA volume [high/low]). Cox proportional hazard regression analyses examined associations between treatment and overall, event-free, and relapse-free survival outcomes. Forty-seven hospitals delivered induction therapy to 351 patients (181 ALL and 170 AML), with 74 (21%) treated at pediatric centers; 70% of hospitals treated less than two AYA leukemia patients per year. Regardless of treatment center, 82% of ALL patients were on pediatric protocols. For AML, pediatric protocols were not used in adult centers, with adult centers using a non-COG 7+3-type induction protocol (51%, where COG is Cooperative Oncology Group) or an ICE-type protocol (39%, where ICE is idarubicin, cytarabine, etoposide). Exploratory analyses suggested that for both ALL and AML, AYAs selected for adult protocols have worse overall, event-free, and relapse-free survival outcomes. Pediatric protocols were commonly used for ALL patients regardless of where they are treated, indicating rapid assimilation of recent evidence by Australian hematologists. For AML, pediatric protocols were only used at pediatric centers. Further investigation is warranted to determine the optimal treatment approach for AYA AML patients.
Link
Citation
Pediatric blood & cancer 2018; 65(11): e27349
Jornal Title
Pediatric blood & cancer

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