Abstract 4365: Comorbidities at diagnosis are associated with poor outcomes among pediatric acute lymphoblastic leukemia and lymphoblastic lymphoma patients

Abstract

Abstract The influence of comorbidities at index diagnosis on outcomes of pediatric leukemia and lymphoma is not well established. We evaluated the association between medical comorbidities and pediatric acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL) outcomes in a retrospective cohort study using electronic health records from the TriNetX Research Network Database, a global de-identified federated health research network. Study participants included pediatric (≤21 years) patients newly diagnosed with ALL or LL from July 2009-June 2019 and followed through June 2022. The main outcomes included progression/relapse, toxicity, overall mortality and cancer-specific mortality. Comorbidities included chronic lung disease; congenital heart disease; neurologic, immune, hematologic, vascular and genetic disorders; renal disease; gastrointestinal disease; prematurity and hepatobiliary disease. Patients with any comorbidity were matched with patients with no comorbidity on age at diagnosis, gender, race/ethnicity, and treatment using propensity score matching. We identified 5,375 patients diagnosed with ALL/LL with comorbidities and 5,375 without comorbidities after propensity score matching. The mean age at diagnosis was 9.7 years (standard deviation=6.2). A higher proportion of the patients were male (56.9%), White (63.6%) and Not Hispanic or Latino (63.4%). Patients diagnosed with comorbidities had a higher risk for progression/relapse (73% vs 51%; Relative Risk, RR=1.42, 95% confidence interval (CI)=1.38-1.47) and treatment related toxicity (80% vs 50%; RR=1.59, 95% CI=1.54-1.64), compared to patients diagnosed with no comorbidities. Similarly, overall mortality (Hazard ratio, HR=1.62, 95% CI=1.37-1.91) and cancer-specific mortality (HR=4.39, 95% CI=2.28-8.46) were higher among patients diagnosed with comorbidities than those without comorbidities. Comorbidities among patients diagnosed with ALL/LL is associated with poor outcomes independent of treatment and thus targeted interventions for the proper management of these patients are needed to improve outcomes. Citation Format: Maua Mosha, Jennifer Mayer, Ernest K. Amankwah. Comorbidities at diagnosis are associated with poor outcomes among pediatric acute lymphoblastic leukemia and lymphoblastic lymphoma patients. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4365.