While children and older adults with acute lymphoblastic leukemia (ALL) are treated at pediatric and adult cancer centers respectively, adolescents and young adults (AYAs; 15 to 39 years) represent a unique patient group that can be treated in either setting. According to a recent report evaluating patterns of care, only 32.3% of AYA patients are referred to pediatric settings, with the majority being treated in adult cancer settings, primarily in community practices. However, AYA patients with ALL had better outcomes, including superior overall survival (OS) and leukemia-specific survival (LSS), when treated in pediatric specialty centers or National Cancer Institute (NCI)-designated/Children’s Oncology Group (COG) cancer centers vs adult cancer centers. One major difference between pediatric and adult settings is the use of pediatric treatment regimens, with only 24.8% utilization in adult vs 100% in pediatric settings. However, regimen choice alone did not account for the difference in outcomes, as choice of a pediatric vs adult regimen was not a significant predictor of outcomes among AYA patients treated in an adult treatment center. The authors suggest that factors such as minimal residual disease-driven ALL treatment algorithms, clinical trial enrollment, and therapeutic adherence strategies might play a role in the disparity of outcomes between treatment settings. These findings support referral of AYA ALL patients, especially those younger than 25 years of age, to pediatric and NCI-designated/COG cancer centers.
High Altitude: The results of this report highlight an unmet need for better referral processes for AYA with ALL. This underscores the need for sharing best practices for pediatric treatment regimens for ALL with oncologists in centers that treat AYA patients. In the meantime, clinicians in pediatric specialty centers could establish relationships with community oncologists to improve the referral process and ensure that AYA patients receive the most appropriate care.
Ground Level: Pediatric-inspired regimens are considered to be the most effective treatments for AYA patients with ALL. Notably, AYA age limit reaches 39 years, which might surprise general oncologists that do not treat ALL commonly. However, there are additional considerations beyond the regimens themselves that might benefit AYA patients. Therefore, referral of ALL AYA patients, especially those younger than 25 years of age, to pediatric and NCI-designated/COG cancer centers could serve as a bridge to improve outcomes until best practices for care of AYA patients can be captured and integrated into practices treating primarily adult ALL cases.