Incidence and Characteristics of Psychiatric Disorders in Adolescent and Young Adult Patients with Malignant Brain Tumors.

Outcomes of Allogeneic Transplantation for Adult T-Cell Leukemia/Lymphoma in Adolescents and Young Adult (AYA) and Young Patients

Risk-Adjusted Therapies Yield Equivalent Outcomes for Adolescents and Young Adults (AYAs) Treated for Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia (T-ALL) on Children's Oncology Group (COG) Studies AALL0434 and AALL1231

Outcome in Adolescent and Young Adult (AYA) Patients Compared to Younger Patients Treated for High-Risk B-Lymphoblastic Leukemia (HR B-ALL): Report from the Children's Oncology Group Study AALL0232

Food Insecurity, Quality of Life, Healthcare Utilization, and Clinical Disease Outcomes in AYA Patients with Sickle Cell Disease

Effects of Post-Transplant Cyclophosphamide on Outcomes of Allogeneic Stem Cell Transplant Are Different between Older and Younger Adult Patients: A Single Institutional Experience

CRA9508 Background: Historically, AYA patients (>16yrs of age) with HR-ALL have an inferior outcome compared to HR-ALL patients 1-15 yrs old, due to increased rates of both relapse and toxicity. Methods: AALL0232 was a phase III randomized trial for patients 1-30 years of age with newly diagnosed B-precursor HR-ALL that utilized a 2 x 2 factorial design with an augmented intensity Berlin-Frankfurt-Münster (BFM) backbone. Patients were randomized to receive dexamethasone versus prednisone during Induction and high dose methotrexate versus escalating Capizzi methotrexate during Interim Maintenance I. A total of 2,574 eligible, evaluable, non-Down Syndrome, non-very high risk patients were randomized between January 2004 and January 2011. AYA patients comprised 20% of this group (n=501; 16-21 yrs: 466 and 22-30 yrs: 35). Results: The 5-yr event-free survival (EFS) and overall survival (OS) rates were 68.0% and 79.8% for AYA patients compared to 80.9% and 88.4% for younger patients (p<0.0001). The 5-yr cumulative incidence of relapse was 21.3% for AYA patients and 13.4% for younger patients (p=0.0018), largely due to higher rate of marrow relapse (15.2% vs. 9.0%; p<0.0007) and not CNS relapse (5.2% vs. 3.7%; p=0.5776). In addition, fewer AYA patients achieved remission, defined as <5% marrow blasts at end induction (97.2% vs. 98.8%; p=0.0134). There was no significant difference in induction mortality between AYA and younger patients, 2.4% vs. 1.8% (p=0.36). However post-induction remission deaths were significantly higher in AYA compared with younger patients, 5.5% vs. 2.1% at 5 years (p<0.0001). Conclusions: This is the largest cohort of AYA ALL patients presented to date and confirms high cure rates for AYA patients treated on pediatric ALL trials. AYA HR-ALL patients had lower EFS and OS compared to younger patients, primarily attributable to both higher rates of marrow relapses and remission deaths. Effective strategies to improve the outcome of AYA patients with HR-ALL should be aimed at both furthering leukemia eradication and lowering toxicity of therapy for this patient population.

e23083 Background: Breast cancer is the most common cancer among adolescent and young adult (AYA) women in the US, accounting for 15% of all invasive cancers. AYA women are more likely to be diagnosed with de novo metastatic breast cancer (MBC); they also have unique cancer care needs. The characteristics of inpatient hospitalizations and outcomes in this population have not been investigated. Methods: Using the Agency for Healthcare Research and Quality (AHRQ) sponsored Healthcare Cost and Utilization Project – National Inpatient Sample (HCUP-NIS) database, we conducted a retrospective cohort analysis among female AYA MBC patients from 2016-2020. Descriptive analyses were used to compare sociodemographic and clinical characteristics between AYA and older patients. Multivariable logistic and linear regression analyses examined the association between age groups and inpatient mortality, length of stay (LOS), and hospital charges based on a 1:10 propensity score matched cohort (by race/ethnicity, hospital region, hospital location, income quartiles, insurance type, Charlson comorbidity index). Results: There were 73,873 female MBC patient hospitalizations within the 5-year period. Of these, 4,252 (5.8%) were AYA (15-39 years). The mean age was 34.6 years in the AYA group and 64.3 years in the older group. AYA patients were more likely to be Black (26.5% vs 18.1%; p < 0.001) or Hispanic (16% vs 9%; p < 0.001), obese (57.3% vs 48.3%; p < 0.001), and have private insurance (46.2% vs 30.1%, p < 0.001) or Medicaid (37.4% vs 13.3%, p < 0.001). Compared to AYA patients, older patients had a higher likelihood of being discharged to a short term/skilled nursing facility or with home health. AYA patients were less likely to have heart failure, chronic kidney disease or liver disease than older patients. Furthermore, AYA patients had lower odds of inpatient mortality (AOR: 0.83; 95% CI 0.73–0.94), shorter hospital stays (AOR: 0.88; 95% CI: 0.82–0.95) but more ICU admissions (AOR: 1.57; 95% CI 1.10–2.24) and higher total hospital charges (b: $4,431; 95% CI $1,384–$7477) relative to older patients. Conclusions: Our findings highlight distinct characteristics and hospital associated outcomes, emphasizing the need for tailored healthcare strategies to address the unique challenges faced by AYA MBC patients. Further research is needed to identify the factors driving these disparities and optimize care for this vulnerable population. Characteristics and outcomes of female AYA metastatic breast cancer patients. AYA patients Older patients p value Weighted % Obese 57.3 48.3 <0.001 Transfer to facility 8.2 20.7 <0.001 Discharged with home health 20.4 26.7 <0.001 Chemotherapy 1.5 0.6 <0.001 Radiation 0.4 0.2 0.045 AOR (95% CI) Inpatient mortality 0.83 (0.73–0.94) Ref 0.004 Length of stay >5 days 0.88 (0.82–0.95) Ref 0.001 ICU admissions 1.57 (1.10–2.24) Ref 0.012 β (95% CI) Total hospital charges 4431 (1384–7477) Ref 0.004

9563 Background: Melanoma is the third most common cancer in adolescent and young adults (AYA), a unique cohort defined as patients between 15-39 years of age per the National Cancer Institute. Immune checkpoint inhibitors (ICI) have changed the landscape for advanced melanoma treatment, and the gut microbiota has been shown to remodel the tumor microenvironment to improve ICI efficacy. There is a paucity of research in this cohort, however studies show that AYA patients, in general, have historically not seen the same survival gains as other age groups. Furthermore, literature shows that survival was much worse for AYA's with stage IV melanoma than observed among older adults. Methods: The AYA cohort in this retrospective review is from the 2021 Science publication entitled "Dietary fiber and probiotics influence the gut microbiome and melanoma immunotherapy response". This cohort was matched on a 2:1 basis with older non-AYA patients 50-70 years of age. We controlled for sex, BMI, race, treatment naivety, stage of disease, as well as smoking, drug, and alcohol status. Results: Our AYA cohort of 23 patients is comprised of 15 females, 22 Caucasians, 20 with primary cutaneous melanoma, 12 with stage III at the start of treatment and 11 with stage IV, 17 were BRAF positive, 8 received combined immunotherapy, 20 were treatment naïve, and 11 were responders. We found no difference in alpha or beta diversity in AYA and older non-AYA patients, however alpha diversity increased with age. This is consistent with literature regarding aging gut microbiomes. Furthermore, we noted the most common microbes found between these groups varied considerably. Using differential analyses, we found, for example, a higher abundance of Ruminococcaceae, at the family level, in older non-AYA patients and a higher abundance of Bacteroides stercoris in AYA patients. Literature shows the relative abundance of Ruminococcaceae increased with age and was significantly higher in older patients. Furthermore, Bacteroides stercoris correlates positively with fiber, grain, and vegetable intake. Additionally, Blautia massiliensia, Blautia obeum, and Dorea longicatena were found to be significantly more prevalent (p=0.010, p=0.34, and p=0.035, respectively)) in older non-AYA patients. These species are all known to be obesity biomarkers. Conclusions: We found that the gut microbiota of AYA and older non-AYA melanoma patients differ. Older non-AYA patients have bacterial species associated with negative biomarkers which may be due to an aging gut microbiome. Establishing microbial features in the AYA population can help with microbiome modulation as a therapeutic strategy. Enriching modalities include fecal microbiota transplantation, probiotics, and improving diet as well as fiber intake. Further research should explore if the gut microbiome influences worse outcomes in AYA's with late stage melanoma.

Acute myeloid leukemia (AML) presents differently across age groups, with unique challenges in the adolescent and young adult (AYA) populations. This study compares clinical characteristics and outcomes between AYA and adult AML patients in Qatar. We conducted a retrospective analysis of 151 AML patients treated at the National Center for Cancer Care and Research, Qatar, between 2017-2021. Patients were divided into AYA (15-39 years, n=73) and adults (≥40 years, n=78) groups. Clinical characteristics, cytogenetic profiles, treatment approaches and survival outcomes were compared between groups. AYA patients (median age 30 years) showed distinct characteristics compared to adults (median age 53.9 years). AYA patients had lower platelet counts (62,900/mm³ versus 96,500/mm³, p=0.016) and higher blast percentages in peripheral blood and bone marrow (60% versus 40%, p=0.02). Core binding factor rearrangements were more common in AYA patients (32% versus 12%, p=0.03), while adult patients had more diploid karyotypes (55% versus 36%). AYA patients received more intensive therapy, with higher rates of FLAG-Ida salvage therapy (34% versus 15%) and allogeneic transplantation (32% versus 15%, p=0.01). While transplantation significantly improved survival in adults, its impact was less pronounced in AYA patients. Median overall survival was comparable between groups (23.14 versus 24.08 months, p=0.09). Our study reveals distinct biological and clinical characteristics between AYA and adult AML patients in Qatar. Despite receiving more intensive therapy, AYA patients showed comparable survival outcomes to adults, suggesting the need for age-specific treatment approaches. The differential impact of transplantation between age groups highlights the importance of personalized treatment strategies. These findings contribute to understanding age-specific differences in AML and may help optimize treatment approaches for both populations.

218 Background: Given the occurrence of cancer during a complex developmental time, adolescent and young adult (AYA) patients have unique psychosocial needs, necessitating supportive care guidelines including National Comprehensive Cancer Network (NCCN) AYA guidelines. We sought to assess compliance with NCCN AYA guidelines and compare to oncology provider identified AYA care needs. Methods: Retrospective chart review was performed on AYA patients (15-39 years) with sarcoma seen at least once in 2019 at the University of Wisconsin (UW), identifying documentation of discussions deemed critical per NCCN AYA guidelines. As per ASCO’s Quality Oncology Practice Initiative certification, we considered a threshold of 75% or higher to be compliant. Compliance was compared with an electronic survey of UW oncology providers regarding AYA patient needs, with items determined to have adequate resources if noted sufficient by >75% of providers. Results: We identified 43 AYA patients with sarcoma. As seen in table, <75% of patients had documentation regarding contraception, fertility, finances, genetics, social work referral and clinical trials indicating non-compliance. Surveys, completed by 38 oncology providers, showed significant discordance between provider’s perception of adequate access to resources and compliance on chart review. Conclusions: Disparities between oncology provider assessment of AYA care needs and lack of documentation of critical components of AYA patient care demonstrates the need for novel tools to evaluate AYA care needs beyond provider assessments. Care needs identified in our study will serve as the basis of an ongoing quality improvement project to better support AYA patients at UW. [Table: see text]

Allogeneic Hematopoietic Cell Transplantation for Adolescent and Young Adult Patients with Acute Myeloid Leukemia

9506 Background: In the CCG 2961 trial for newly diagnosed AML, adolescent and young adult patients (aged 16-21 years, AYA) had inferior survival relative to younger patients. To more broadly define the impact of older age on outcomes in this setting and to identify factors responsible for its effect, we performed an analysis utilizing data from 4 COG trials. Methods: We compiled data from the CCG 2891, CCG 2941, CCG 2961 and AAML03P1 trials. For the 2891 trial, we utilized only the data from patients assigned to the intensively timed treatment arm. We compared the demographics, disease-related characteristics and outcomes of the AYA patients to those of younger patients. Results: The data set included 238 AYA patients (median age=17.2 years) and 1,602 younger patients (median age=6.9 years). There were no significant differences between the groups in race or gender. A greater proportion of the AYA patients were overweight (19.9% vs. 13.2%, p=0.009) and had a matched related donor available (29.0% vs. 21.7%, p=0.016). Using cytogenetics and molecular abnormalities (FLT3, CEBPA, NPM) to define poor, favorable and standard risk groups, a greater proportion of AYA patients had poor risk disease (16.6% vs. 10.4%, p=0.026) and a smaller proportion had standard risk disease (50.3% vs. 61.8%, p=0.006). At 5 years, AYA patients had marginally poorer overall survival from study entry (49 +/-7% (+/-2SE) vs. 54 +/-3%, p=0.058). AYA patients had a higher cumulative incidence of TRM from study entry (25+/-6% vs. 12+/-2%, p<0.001), but lower cumulative incidence of relapse from end of first course (30+/-7% vs. 41+/-3%, p=0.002). Infection accounted for most cases of TRM in both age groups. Multivariate analyses results will be presented. Conclusions: Our preliminary results suggest that AYA patients are more likely to die from treatment related causes but, despite being more apt to have poor risk disease, they are less likely to die from leukemic relapse than younger patients. As a result, survival rates in AYA and younger patients are similar. Our results also suggest that efforts to develop more effective strategies for preventing infection during AML therapy could reap great benefit for AYA patients.

Kidney Cancers in Adolescents &amp; Young Adults

INTRODUCTION Few data exist regarding the epidemiology of brain metastases (BMs) in adolescent and young adult (AYA) patients. Herein we use national cancer registry data to dissect their epidemiology and compare to the adult population. METHODS AYA patients (15 ≤ age ≤ 39) who newly presented with a BM between 2010 and 2017 were identified in the National Cancer Database (comprising &amp;gt;70% of all newly-diagnosed cancers in the U.S.). The epidemiology of BMs was analyzed by primary cancer of origin, and compared between AYA and adult patients. Overall survival was analyzed with multivariable Cox regression. RESULTS 2,773 AYA patients presenting with BMs were identified (98% with histopathological diagnosis), compared to 156,103 adult patients (94% with histopathological diagnosis). Whereas 39.6% of newly-diagnosed brain tumors with histopathological confirmation were BMs in adults, BMs represented only 5.8% of such tumors in AYA patients. Additionally, the distributions of primary cancer types differed substantially between adults and AYA patients: notably, NSCLC dominated in adults (64.2%) vs representing only 31.6% of BMs in AYA patients. AYA patients were more likely to present with BMs from melanoma (13.0% of AYA BMs vs 3.7% in adult), soft tissue (4.5% vs 0.3%), testicular (in males 26.2% vs 0.1%), and breast (in females 29.5% vs 7.8%) primaries. Among breast BMs in females, AYA patients were less likely to have HR+/HER2- primaries (40.2% vs 47.8%) and more likely to have HER2+ (25.2% vs 20.1%) and triple positive (11.1% vs. 9.8%) primaries than adults. Overall survival was significantly longer for AYA patients with BMs (HR=0.61 compared to adult patients, 95%CI:0.58-0.64, p&amp;lt; 0.001) even after adjusting for primary cancer type, patient sex. CONCLUSIONS The epidemiology and cancer types of BMs in AYA patients differ substantially from adult patients. Future research aimed at understanding the unique differences in pathophysiology and outcomes of BMs in AYA patients is warranted.

Adolescent and young adult (AYA) patients with cancer have not seen the same improvements in survival as younger (pediatric) patients and older patients (adults 40 years old or older). This may be related to their lower participation in clinical trials. This study examined AYA patient accrual to SWOG Cancer Research Network phase 1 to 3 clinical treatment trials for 29 cancers over 25 years (January 1996 to December 2020). Trial enrollments for AYA patients (15-39 years old) were compared with trial enrollments for older patients (40 years old or older) in SWOG and with US AYA cancer population rates derived from US Census and National Cancer Institute/Surveillance, Epidemiology, and End Results data. In total, 84,219 patients were enrolled in SWOG treatment trials, including 7109 AYA patients (8.4%); in contrast, AYAs constituted 3.8% of the US cancer population. By histology, the highest proportions of AYA patients were in trials for Hodgkin disease (825 of 1220; 67.6%) and acute lymphocytic leukemia (350 of 678; 51.6%), whereas breast cancer trials had the greatest number of AYA patients (3032 of 32,693; 9.3%). SWOG AYA patients were more often female (68.8% vs 58.7%; P < .001), Black (10.1% vs 8.2%; P < .001), and Hispanic (10.6% vs 5.6%; P < .001) than SWOG patients who were 40 years old or older, and they were more often female (68.8% vs 65.1%; P < .001) but less often Black (10.1% vs 11.8%; P < .001) or Hispanic (10.6% vs 12.8%; P < .001) than AYA patients in the US cancer population. AYA patients with cancer were well represented in SWOG clinical trials in comparison with US cancer population patients with the same cancers. The SWOG AYA population was more racially/ethnically diverse than older SWOG patients, although it was less diverse than the US AYA cancer population. Adolescent and young adult (AYA) patients with cancer (aged 15-39 years) have not seen the same improvements in survival as younger (pediatric) patients and older patients (adults 40 years old or older). This may be related to their lower participation in clinical trials. This study evaluated the extent to which AYA patients were enrolled in a large, National Cancer Institute-sponsored network group over 25 years (1996-2020). Overall, 8.4% of the enrolled patients (7109 of 84,219) were AYAs; this was twice the corresponding rate of 3.8% in the US cancer population. AYA patients were also more racially/ethnically diverse than older trial patients, although they were less racially/ethnically diverse than the US AYA cancer population.