Real world outcomes of veterans 18-45 years old with acute lymphocytic leukemia.

Abstract

e18852 Background: Age is a strong prognostic factor in acute lymphocytic leukemia (ALL), with children doing better than adults with the same disease. One hypothesis for this age-based disparity is differences in treatment regimens. Current NCCN guidelines say it is acceptable to treat young adult patients with either pediatric or adult regimens. We conducted a retrospective study of all veterans with ALL diagnosed between the ages of 18-45 since the year 2000 to evaluate the effect of different treatment regimens on overall survival. We also evaluated other disparities that exist among young adults with ALL including race and enrollment in clinical trials. Methods: Electronic medical record data from the Veterans Affairs Corporate Data Warehouse was used to identify patients with an ICD 9 or 10 code for ALL. All patients were chart checked to confirm ALL diagnosis and excluded if they were diagnosed before 2000, had childhood ALL, or if induction protocol was not recorded. 260 patients were included in the final analysis, including 130 treated with a pediatric-inspired regimen. Kaplan-Meier and Cox regression analyses were used to compare overall survival between patients treated on a pediatric-inspired regimen and patients treated on an adult regimen. Multivariate analysis was performed with controls for age, ALL subtype (B, T, mixed phenotype), Ph status, cytogenetic risk (based on modified MRC-ECOG study), obesity (BMI > 30), and race. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariable Cox regression to estimate associations with risk of 5-year death. Results: Patients treated on a pediatric regimen had statistically significant survival gains, with a HR of 0.41, p < 0.001, after controlling for obesity, Ph status, ALL subtype and cytogenetic risk. Pediatric-regimen survival gains were similar for patients ages 30-45 (HR 0.5, p = 0.037). White patients had significantly improved OS compared to people of color (HR 0.55, p = 0.013) after controlling for the aforementioned covariates. Black patients were far less likely (23%) to receive a transplant than non-Black patients (46%). Only 7% of patients were treated on a clinical trial. Patients ages 30-45 were 83% less likely to be enrolled in a clinical trial and 24% less likely to receive a pediatric-regimen than younger adults. Conclusions: This data demonstrates that treatment with a pediatric regimen significantly improves overall survival in patients up to the age of 45. The data also suggests ongoing shortcomings in treatment for young adults with ALL, especially 30 to 45 yos, including persistently high use of adult induction regimens, low rates of referral to clinical trials, and significant racial disparities in bone marrow transplants for Black patients. [Table: see text]