Abstract
Hodgkin lymphoma (HL) is a common adolescent and young adult (AYA) cancer. While outcome disparities between pediatric vs. adult centers [locus of care (LOC)] have been demonstrated in other AYA cancers such as acute lymphoblastic leukemia, they have not been well studied in HL. We therefore compared population‐based treatment patterns and outcomes in AYA HL by LOC. The IMPACT Cohort includes data on all Ontario, Canada AYA (15‐21 years) diagnosed with HL between 1992 and 2012. Linkage to population‐based health administrative data identified late effects. We examined LOC‐based differences in treatment modalities, cumulative doses, event‐free survival (EFS), overall survival (OS), and late effects. Among 954 AYA, 711 (74.5%) received therapy at adult centers. Pediatric center AYA experienced higher rates of radiation therapy but lower cumulative doses of doxorubicin and bleomycin. 10‐year EFS did not differ between pediatric vs. adult cancer vs. community centers (83.8% ± 2.4% vs. 82.8% ± 1.6% vs. 82.7%±3.0%; P = .71); LOC was not significantly associated with either EFS or OS in multivariable analyses. Higher incidences of second malignancies in pediatric center AYA and of cardiovascular events in adult center AYA were observed, but were not significant. In conclusion, while pediatric and adult centers used different treatment strategies, outcomes were equivalent. Differences in treatment exposures are however likely to result in different late‐effect risks. Protocol choice should be guided by individual late‐effect risk.
Highlights
Adolescents and young adults (AYA) with cancer are an understudied group often combined with either children or older adults in clinical trials
954 AYA were diagnosed with Hodgkin lymphoma (HL), 711 (74.5%) of whom were treated in adult centers
As compared to AYA at adult centers, pediatric center AYA were younger and more likely to be treated in the later time period
Summary
Adolescents and young adults (AYA) with cancer are an understudied group often combined with either children or older adults in clinical trials. Hodgkin lymphoma (HL) is a common AYA malignancy, representing 12% of cancers among 15-29-year-olds.[5] Among patients treated on the adult studies of the German Hodgkin Study Group, the outcomes of adolescents aged 15-20 years were similar to those aged 21-45 years.[6] In contrast, on recent Children's Oncology Group HL trials, event-free survival (EFS) was inferior among AYA compared to younger children.[7] It is still unclear whether AYA with HL should be offered adult or pediatric protocols.[8] Pediatric protocols have generally followed a strategy of upfront chemotherapy dose intensity in order to limit cumulative doses of chemotherapy. Whether pediatric protocols offer an advantage in either outcome or the risk of late effects is unknown
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