Adolescent And Young Adult Patients Research Articles

Treatment of Medulloblastoma in the Adolescent and Young Adult Population: A Systematic Review.

Medulloblastoma is the most frequent high-grade tumor of the central nervous system in children but accounts for less than 1% of these tumors in adults. Adolescent and young adult (AYA) patients are between both age groups, and different approaches are used to treat medulloblastoma in this population. We performed a systematic review of studies published between 2007 and 2023 that reported treatment approaches and survival data of AYA patients with medulloblastoma, defined as 15 to 39 years of age at diagnosis. Due to the heterogeneity of data, a meta-analysis was not possible. Except for the omission of chemotherapy after radiotherapy in a few adult studies, the treatment backbone is very similar between studies starting enrolment during childhood and older adolescence or adulthood. Despite indications for a higher rate of early treatment termination due to toxicity in adults, survival data remain comparable between studies starting enrolment earlier or later in life. However, molecular subtyping was missing in most studies, so the survival data must be interpreted cautiously. Nevertheless, pediatric-inspired strategies in the AYA population are feasible, but individual dose adjustments may be necessary during treatment and should be considered upfront. Collaborative studies investigating the best treatment approach for medulloblastoma in the AYA population are needed in the future.

Allogeneic stem cell transplant with TBI-based myeloablative conditioning in adolescents and young adults with Philadelphia chromosome-negative ALL treated with pediatric protocols

To investigate the safety of total body irradiation-based myeloablative conditioning (TBI-MAC) in adolescent and young adult (AYA) Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL) patients treated with pediatric protocols, treatment outcomes of 106 AYA patients aged 16–39 years old undergoing allogeneic stem cell transplant (allo-SCT) with TBI-MAC in the first remission were compared according to chemotherapy types before transplant. Pediatric and adult protocols were used in 56 and 50 of the patients, respectively. The cumulative incidence (CI) of non-relapse mortality (NRM) and the overall survival (OS) rates were not significantly different between the pediatric-protocol and adult-protocol group (NRM: 4 % vs. 14 % at five years post-transplant, respectively, p = 0.26; OS: 81 % vs. 66 %, respectively, p = 0.14). Multivariate analysis for NRM revealed that a performance status >0 (hazard ratio [HR] = 4.8) and transplant due to chemotherapy toxicities (HR = 3.5) were independent risk factors, but a pediatric protocol was not (HR = 0.48). The CI of NRM and the OS rates were also similar among patients aged over 24 years old. These findings suggested that conventional allo-SCT with TBI-MAC can be performed without increasing NRM in AYA patients with Ph-negative ALL even after pediatric protocols.

Stereotactic Ablative Radiation Therapy (SABR) for Adolescent and Young Adult Malignancies.

There are limited studies examining local control (LC) and overall survival (OS) following stereotactic ablative radiation therapy (SABR) for adolescent and young adult (AYA) populations/histologies with local recurrences or metastatic disease. The RSSearch® Patient Registry, an international SABR registry, was evaluated for AYA patients treated with SABR. AYA patients with adult histologies/primaries were excluded. Kaplan-Meier analyses were employed to characterize LC and OS following SABR. Potential prognostic factors were assessed with log-rank tests for initial univariate analysis (UVA). For multivariate analyses (MVA), a Cox proportional hazards multivariate model was utilized. A total of 19 AYA patients with 39 lesions treated with SABR were identified and included in the analysis. Four lesions (10.3%) were treated with SABR for primary tumor recurrence and 35 lesions were treated for metastatic disease. The median patient age was 34 years (range: 16-39 years). Common lesion locations included lung (11 lesions; 28.2%), non-spinal bone (nine lesions; 23.1%), and spine (six lesions; 15.4%). The median biological effective dose (BED10) was 61.5 Gy (range: 26.4-180). One-year LC and OS following SABR were 77.7% (95% CI: 58.5-88.7) and 72.7% (95% CI: 46.3-87.6), respectively. On UVA, BED10 ≥ 60 Gy was associated with superior one-year LC (94.4% vs. 47.6%; p<0.0001) as were sarcoma primaries (two-year LC: 92.3% vs. 42.2%;p = 0.0002). Central nervous system (CNS) primaries had significantly poorer one-year LC (20% vs 87.5%; p<0.0001) as well as spinal metastases (33.3% vs. 87.0%; p<0.0001). On MVA, BED10 < 60 Gy was associated with inferior LC (hazard ratio (HR) = 5.51;p = 0.01) with sarcoma primaries associated with superior LC (HR = 0.04;p = 0.008). SABR with BED10 ≥ 60 Gy resulted in durable LC for AYA patients, particularly those with sarcoma primaries, though poor outcomes were noted in metastatic CNS malignancies.

Racial Disparities in Cancer Stage at Diagnosis and Survival for Adolescents and Young Adults

There are limited studies assessing stage at diagnosis and risk of death among all 5 federally defined races in the US among adolescent and young adult (AYA) patients with cancer. To identify racial disparities in stage at diagnosis and survival among AYA patients with cancer. This retrospective cohort study used data from a US national hospital-based oncology database on AYA patients, aged 15 to 39 years, with the 10 deadliest cancers among AYA patients who received a diagnosis from January 1, 2004, to December 31, 2017, with 6 months or more of follow-up. Analyses by race were categorized by the 5 federally defined races in the US: American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and non-Hispanic White (hereafter, White). White patients served as the majority reference group. Statistical analysis was performed from November 2022 to September 2023. The primary end points were late stage at diagnosis (logistic regression with adjusted odds ratios [AORs] and 95% CIs) and overall survival (log-rank tests and Cox proportional hazards regression with adjusted hazard ratios [AHRs] and 95% CIs). A total of 291 899 AYA patients (median age, 33 years [IQR, 28-37 years]; 186 549 female patients [64%]; 189 812 [65%] with stage I or II cancers) were evaluated. The cohort included 1457 American Indian or Alaska Native patients (1%), 8412 Asian patients (3%), 40 851 Black patients (14%), 987 Native Hawaiian or Other Pacific Islander patients (0.3%), and 240 192 White patients (82%). Cancers included breast (n = 79 195 [27%]), lymphoma (n = 45 500 [16%]), melanoma (n = 36 724 [13%]), testis (n = 31 413 [11%]), central nervous system (n = 26 070 [9%]), colon or rectum (n = 22 545 [8%]), cervix (n = 20 923 [7%]), sarcoma (n = 14 951 [5%]), ovary (n = 8982 [3%]), and lung (n = 5596 [2%]). Risk of late-stage diagnosis was higher for Asian (AOR, 1.20; 95% CI, 1.14-1.26), Black (AOR, 1.40; 95% CI, 1.36-1.43), and Native Hawaiian or Other Pacific Islander (AOR, 1.34; 95% CI, 1.16-1.55) patients compared with White patients. Overall survival differed by race for all cancer sites, except cancers of the central nervous system and ovary. Risk of death was higher for American Indian or Alaska Native (AHR, 1.15; 95% CI, 1.02-1.30), Black (AHR, 1.22; 95% CI, 1.19-1.26), and Native Hawaiian or Other Pacific Islander (AHR, 1.25; 95% CI, 1.09-1.44) patients but lower for Asian patients (AHR, 0.90; 95% CI, 0.85-0.95) compared with White patients. This cohort study of AYA patients suggests that stage at diagnosis and survival varied across races for the 10 deadliest AYA cancers. These results support the need for tailored interventions and informed public policy to achieve cancer care equity for all races.

Harmonization of the Upfront Osteosarcoma Treatment Paradigm for Adolescents and Young Adults.

Limited guidance exists on streamlining cancer therapy for adolescent and young adult (AYA) patients 15-39 years of age, as much of the current data are extrapolated from pediatric or adult counterparts and can differ significantly between the two care models. Harmonization of standard treatment approaches has the potential to improve outcomes and establish a foundation for the development of future clinical trials. We present our experience harmonizing treatment and supportive care regimens for AYA patients with osteosarcoma receiving treatment with methotrexate, doxorubicin, and cisplatin (MAP) therapy on the pediatric and adult sarcoma services at the Memorial Sloan Kettering Cancer Center.

Temporal trends of adolescents and young adults (AYA) with gynecologic malignancy in the United States

In this retrospective cohort study examining 13,763,447 patients with 16 different malignancies, including 1,232,841 patients with five gynecologic malignancies (uterus [n = 690,590], ovary [n = 276,812], cervix [n = 166,779], vulva [n = 81,575], and vagina [n = 17,085]), identified in the Commission-on-Cancer’s National Cancer Database from 2004 to 2020, cervical cancer (25.3 %) had the highest rate of adolescent and young adult (AYA) patients among 27 gender-stratified cancer groups (25.3%). There were 8 groups that the annual rates of AYA patients statistically increased during the study period at a P < .05 level, of which 7 (87.5 %) groups were for female malignancies. Among these 7 female malignancies, the annual percentage rate increase in AYA patients was largest for colorectal cancer (4.1 %, 95 % confidence interval 3.6–4.6), followed by malignancies in the ovary (3.1 %, 95 % confidence interval 1.6–4.5 in 2014–2020), pancreas (2.1 %, 95 % confidence interval 1.0–3.2), uterus (1.2 %, 95 % confidence interval 0.3–2.0 in 2013–2020), breast (0.8 %, 95 % confidence interval 0.2–1.4 in 2012–2020), cervix (0.8 %, 95 % confidence interval 0.2–1.5 in 2011–2020), and kidney (0.4 %, 95 % confidence interval 0.1–0.9). In conclusion, these data suggested that proportion of cancers attributable to AYA patients is increasing in several obesity-related female malignancies and in the three most common gynecologic malignancies.

Feasibility and Clinical Utility of Patient-Reported Outcome Measurement Information System-29 in a Newly Established Adolescent and Young Adult Oncology Program.

Purpose: Despite improvements in survival, adolescent and young adult (AYA) oncology patients are at high risk for experiencing negative health-related quality of life (HRQOL) outcomes. AYA cancer programs have attempted to develop assessment tools to identify areas of need. We aimed to demonstrate the feasibility/utility of the Patient-Reported Outcome Measurement Information System®-29 (PROMIS®-29) within an AYA oncology program clinic. Methods: AYA patients were referred by oncologists to the AYA oncology program at Prisma Health. The PROMIS-29 v2.0 survey was administered to AYAs at point of care. Feasibility of distribution and completion rate of surveys were determined. PROMIS surveys were self-reported and subsequently scored using standardized methods. The domains assessed included physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles/activities, pain interference, and pain intensity. Qualitative descriptions of AYA care delivery based on survey responses at the patient level and programmatic level are also presented. Results: Between May 2017 and 2019, 134 AYAs who were newly diagnosed or in treatment completed the survey. Distribution and completion rates for the PROMIS-29 were both 100%, and meaningful changes in program-level services were implemented as a result of PROMIS-29 score patterns. Within the entire cohort, T-scores for anxiety, fatigue, and physical function reached clinically relevant thresholds. Conclusion: PROMIS offers a feasible opportunity for AYA programs to measure clinically useful HRQOL outcomes in AYAs. The survey can be used to deliver real-time AYA care to recently diagnosed and in-treatment AYAs and make programmatic changes within AYA oncology programs.

Asking the "Right" Questions about Financial Hardship: Using Cognitive Interviews with Adolescents and Young Adults with Cancer and Their Caregivers to Inform Measure Development.

Purpose: Financial hardship as a result of cancer treatment can have a significant and lasting negative impact on adolescents and young adults (AYAs) and their families. To address a lack of developmentally informed and psychometrically sound measures of financial hardship for AYAs and their caregivers, we used rigorous measurement development methods recommended by the National Institutes of Health's Patient-Reported Outcomes Measurement Information System® (PROMIS®) to determine comprehensibility and relevance of measure content. Methods: Our multi-step approach involved item identification, refinement, and generation; translatability and reading level review; and cognitive interviews. A purposive sample of 25 AYAs and 10 caregivers participated, ensuring representation across age, education, gender, race/ethnicity, and cancer type. Results: Fifty patient-reported and caregiver-reported items were developed across material, psychosocial, and behavioral subdomains of financial hardship. Translatability and reading level reviews resulted in 22 patient-reported and 25 caregiver-reported items being rewritten. Eighty-eight percent of patients and all caregivers described the items as easy to answer. Younger AYAs (15 to 25 years of age) were more likely to say the items were less relevant for them. Forty-six patient-reported and 48 caregiver-reported items were recommended for further testing. Conclusion: This study is the first to use in-depth qualitative methods to center AYA patient and caregiver experiences in the creation of new measures of financial hardship. Data support the comprehensibility and content validity of these preliminary item banks. Future large-scale, quantitative testing will lead to additional refinements and support the use of short forms and computer-adaptive testing for a diverse sample of AYAs and their caregivers.

Piloting a Patient-Driven Online Survey to Better Understand Cancer in Adolescents and Young Adults (AYA) in the United States.

Adolescents and young adults (AYAs) with cancer are a unique patient population in oncology. An opt-in, secure online survey was conducted among a general population of AYA patients and survivors to better understand the current landscape of AYA cancer. A 28-item online survey was designed for cancer patients and survivors diagnosed between the ages of 18 and 39 years.It comprised questions about demographics, treatment site, clinical trial involvement, support services available, and impact on employment, schooling, and finances. A total of 590 patients registered and 447 (76%) completed the survey.This online exercise was found to be feasible and can serve as an effective method to survey the AYA cancer population.

The effectiveness of live music intervention on psychological distress among adolescent and young adult patients undergoing hematopoietic stem cell transplantation

Objective To explore the effects of live music to decrease psychological distress in adolescent and young adult (AYA) patients undergoing hematopoietic stem cell transplantation (HSCT). Method A quasi-experimental study was conducted. Sixty patients undergoing HSCT were divided into two groups, receiving either 4 week of live music (n = 31) or standard care (n = 29). Psychological distress, anxiety, the severity of symptom clusters and symptom interference were measured. Results When compared with the immediately and 1 month after intervention, patients in LM intervention group had significantly lower psychological distress and anxiety level than wait-list group. AYA undergoing HSCT reported significantly milder general symptom cluster and neurological symptom cluster at T3 than at baseline. Conclusions Live music intervention showed a positive effect on relieving psychological distress and anxiety in AYA patients undergoing HSCT. However, further researches are warranted to explore the effects of live music intervention on symptom cluster.

NURS-22. NAVIGATING DISPARITIES: COMPREHENSIVE CARE AND ACCESS TO CLINICAL TRIALS FOR ADOLESCENTS AND YOUNG ADULTS WITH CENTRAL NERVOUS SYSTEM TUMORS

Abstract BACKGROUND Central nervous system (CNS) tumors are one of the most common causes of cancer-related death in the adolescent and young adult (AYA) age group. Despite being a prevalent cancer diagnosis, adolescents and young adults continue to be underrepresented in clinical trials. Literature review shows a notable lack of research focused on clinical care, reproductive health, and psychosocial aspects specific to this population. The longstanding issue of low AYA participation in clinical trials persists across various cancer types, with a particular scarcity of data regarding CNS tumors. Notably, the lack of participation in clinical trials has been associated with worse survival outcomes and increase in frequency and severity of treatment-related toxicity, emphasizing the critical impact of this issue on patients’ overall morbidity and mortality. The literature underscores the under-representation of AYAs with CNS tumors in neuro-oncology trials.. METHODS This talk will review challenges faced by adolescents and young adults (AYAs) diagnosed with central nervous system (CNS) tumors.We will discuss the necessity for molecular profiling in the diagnostic workup of CNS patients to delineate tumor biology and guide treatment plans, including clinical trial access. To address the insufficient understanding of best practices for this group, there is a crucial call for expanding access to clinical trials. We will explore barriers to clinical trial access and provide case examples of successful and unsuccessful work with AYA patients with CNS tumors with ideas to improve access. Finally, we will discuss the holistic care of AYAs with CNS tumors through a multidisciplinary approach, incorporating expertise in neuro-oncology, oncofertility, palliative care, and psychosocial aspects within both pediatric and adult care settings RESULTS N/A CONCLUSIONS By the end of this presentation, pediatric RNs and APPs will have an understanding of the differences in caring for this unique population of patients including benefits of enrolling adolescents and young adults with CNS tumors in clinical trials.

OTHR-21. DEVELOPING A NEURO-ONCOLOGY PROGRAM FOR ADOLESCENTS AND YOUNG ADULTS IN CANADA – THE CANON EXPERIENCE

Abstract BACKGROUND Brain tumors are the leading cause of cancer-related death in adolescents and young adults (AYA). These tumors possess both pediatric-type and adult-type qualities, with up to 30% of gliomas harboring pediatric-type alterations. Specialized expertise and significant collaboration between pediatric and adult providers is needed to guide therapy for AYAs. To address this, we have developed the Canadian Adolescent and Young Adult Neuro-Oncology Network (CANON). METHODS In April 2021, we established a national virtual AYA tumor board integrating comprehensive molecular analysis of available tumors. Rounds included representatives from both pediatric and adult neuro-oncology, radiation oncology, neurosurgery, neuropathology and neuroradiology. We collected clinical data and recommendations from rounds. RESULTS In the first 2 years of rounds through CANON, 156 cases have been reviewed. Gliomas (108) accounted for most cases followed by medulloblastoma (18) and ependymoma (7). Sequencing was available in 47% of cases. Of those with molecular data available, the majority (36) had a pediatric-type alteration, followed by IDH mutation (10). Additional molecular analysis was recommended in 29% of cases presented. Of those with sequencing data available, 35% had a potentially targetable alteration identified. Despite this, only 8% were eligible for a clinical trial based on their diagnosis and age. Recurrent clinical questions included access to molecular analysis, use of “off-label” targeted agents, lack of clinical trial options for AYA patients and the practice variation in treatment of AYA tumors typically seen in childhood such as medulloblastoma and germ cell tumor. DISCUSSION Dedicated AYA rounds have highlighted many inequities in care of these patients, highlighting a need for inclusion of AYAs in clinical trials and further study of tumor biology and clinical outcomes of this cohort. AYAs with pediatric-type tumors would also benefit from management by dedicated physicians with expertise in these complex tumors.

Myeloproliferative neoplasms in the adolescent and young adult population: A comprehensive review of the literature.

Myeloproliferative neoplasms (MPN) are characterized by a clonal proliferation of myeloid lineage cells within the bone marrow. The classical BCR-ABL negative MPNs are comprised of polycythaemia vera, essential thrombocythaemia and primary myelofibrosis. Historically, the majority of MPNs are diagnosed in adults older than 60 years of age; however, in recent years, there has been recognition of MPNs in the adolescent and young adult (AYA) population. AYAs with MPN, typically defined as between the ages of 15 and 39 years old, may comprise up to 20% of patients diagnosed with MPN. They demonstrate unique patterns of driver mutations and thrombotic events and remain at risk for progression to more aggressive disease states. Given the likely long length of time they will live with their disease, there is a significant unmet need in identifying well-tolerated and effective treatment options for these patients, particularly with the advent of disease modification. In this review, we provide a comprehensive overview of the clinical features, disease course and management of AYA patients with MPN and, in doing so, highlight key characteristics that distinguish them from their older counterparts.

Analyzing the gut microbiome in adolescent and young adult patients with melanoma receiving immune checkpoint blockade.

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.

Racial disparities in incidence and survival in renal cell carcinoma in adolescents and young adults (AYA).

e23153 Background: Renal cell carcinoma (RCC) has doubled in incidence over the past 50 years. Most cases are incidentally discovered. AYA cancer is defined as cancer in individuals 15 to 39 years. There is paucity of data in the literature on racial disparities in the incidence and survival outcomes of RCC in AYA. We aim to determine the influence of race on incidence and survival outcomes in AYA. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) 17 program were utilized to obtain annual percentage change (APC) of RCC from 2000-2020 for patients aged 15-39 years. Patient characteristics were expressed in proportions. Relative survival rate (RSR) was used to determine survival outcomes. The 5-year RSR was defined as the percentage of patients alive 5 years after the diagnosis of cancer. SEER*Stat software was used to determine the RSR. Results: We identified 8751 patients with RCC. A higher proportion of cases were males (57.9%) vs females (52.1%). Patients were predominantly non-hispanic whites (NHW, 54.7%), hispanics (24.9%), non-hispanic blacks (NHB, 11.4%), non-hispanic asian or pacific islander (NHAPI, 0.06%) &amp; non-hispanic american indian/alaska native (NHAIAN, 0.01%). There was significant increase in RCC incidence (APC: 4.0%, CI: 3.0, 4.9). Incidence was higher in males (APC: 4.0, CI: 3.1, 5.0) vs females (APC: 3.9, CI: 2.8, 5.0). Incidence was highest in Hispanics (APC: 5.6%, CI: 4.4, 6.8), followed by NHW (APC: 4.1 % CI: 3.1, 5.2, -2.3), NHAPI (APC: 3.3%, CI: 1.2, 5.5) and NHB (APC: 1.5%, CI: 1.1, 2.0). The 5-year RSR was 79.7% (CI: 77.7, 81.6). Survival was greatest in females (RSR: 82.8, CI: 79.8, 85.4) vs males (RSR: 77.3%, CI: 74.4, 79.9). NHB had the lowest survival (RSR: 65.9%, CI: 60.2, 71.0) compared to NHW (RSR: 83.9%, CI: 81.3-86.2). Conclusions: In AYA, RCC incidence has increased; consistent with global trends. Significant racial disparity in incidence and survival exists. Survival in NHB remained poorer than other racial groups despite minimal increase in incidence. More studies are needed to explore the reasons for these racial differences to improve the outcomes among AYA patients. [Table: see text]

Impact of body mass index and karyotype on clinical outcomes in adolescents and young adults (AYA) with acute myeloid leukemia.

6551 Background: Acute myelogenous leukemia (AML) represents 15%–20% of leukemias in children and approximately 33% in adolescents and young adults (AYA) (1). Obesity has been associated with worse outcome in acute lymphoblastic leukemia in AYA patients (pts). To date, however, the relationship between weight and clinical outcomes in AYA pts diagnosed with AML has not been established. We investigated the impact of body mass index (BMI) along with other prognostic factors on outcomes of AYA AML pts receiving intensive chemotherapy and/or allogeneic stem cell transplant (SCT). Methods: This retrospective chart review included pts 18-39 yrs newly diagnosed with AML between 01/2006-12/2023. All pts received intensive chemotherapy with cytarabine- and anthracycline-based induction followed by consolidation chemotherapy +/- SCT. BMI was calculated using height and weight at AML diagnosis. Pts were classified by BMI into under, normal, overweight, or obese categories. AML risk classification (ELN 2022) and HCT co-morbidity index (HCT-CI) were performed. Outcomes included complete response (CR), CR with incomplete counts (CRi), overall response rates (CR+CRi), event free survival (EFS), and overall survival (OS). Results: Eighty-seven pts (median age 25 yrs, range 18-38) were identified. 44 (51%) were male; 85% were Caucasian. Per ELN 2022, 27 (31%) had favorable, 40 (46%) intermediate, and 20 (23%) adverse risk. Overall response rate to chemotherapy was 92% (CR 80%, CRi 12%). CR rate by ELN was 96%, 72% and 58%, respectively. Median OS for all pts was 788 days and per ELN risk was 1379, 569, and 595 days, respectively. Co-morbidity indices (HCT-CI) ranged from 0-5. Sixty-two percent underwent SCT. 29% relapsed. The percentage of pts alive at 2 and 5 years was 54% and 29%. Pts were categorized by BMI: underweight (BMI &lt; 18.5, 6%), normal weight (NW) (BMI 18.5-24.9) (37%), overweight (OW)(BMI 25-29, 26%), and obese (OB) (BMI &gt; 30, 31%) pts. Overall, there was a trend to improved outcomes in NW vs OW and OB pts. Median OS was 1006 (NW) vs 748 (OW) vs 678 (OB) days (p=0.0036 for NW vs OW/OB). Two-year OS was 63%, 52%, and 48%; 5-year OS was 38%, 26%, and 19%. The impact of BMI was dependent on AML karyotype. In favorable risk AML AYA pts, the relapse rate was 4%, 4% and 12%. Median OS was 1982 (NW), 1169 (OW), and 1256 (OB) days (p=0.0525 NW vs OW/OB). Five-year OS was 50%, 25% and 18%. The most common causes of death were GVHD-induced multi-organ failure and respiratory failure which did not correlate with HCT-CI. In intermediate and adverse risk AML, there was no difference in outcomes by BMI. Conclusions: Outcomes of favorable risk AYA AML pts following intensive chemotherapy +/- SCT was influenced by BMI with increased mortality and shorter OS in pts with high BMI (overweight and obese) as compared to normal BMI. Additional studies to confirm this finding and elucidate the underlying reasons are warranted.

Harmonizing cancer care delivery for AYAs with osteosarcoma: Comparison of pediatric and medical oncology approaches in a single center.

10039 Background: Osteosarcoma (OS) has a peak incidence amongst adolescents and young adults (AYA). Nuances in chemotherapeutic regimens are largely influenced by the training of pediatric or medical oncologists. MAP is the standard chemotherapy regimen used by pediatric oncologists. Chemotherapy regimens used by medical oncologists vary; our center uses preoperative doxorubicin/cisplatin (AP) followed by either doxorubicin/ifosfamide (AI) or a combination of HD methotrexate and HD ifosfamide. We undertook this analysis to characterize the treatment response, toxicity, and survival outcomes for AYAs with OS treated with pediatric vs medical oncology regimens as an initial step towards harmonizing our institutional approach to the treatment of AYA patients with bone sarcomas. Methods: We retrospectively reviewed the records of AYAs with OS receiving primary treatment at our center. Clinicopathologic characteristics and outcomes for patients treated with MAP vs. AP+ were compared. Progression-free survival (PFS) was defined as the time from either MAP/AP+ initiation or surgery to the time of first recurrence or death. Overall survival was defined as the time from MAP/AP+ initiation or surgery to death. The distributions of PFS and overall survival were estimated by the Kaplan-Meier method. Log-rank test was performed to test the difference in survival between groups. Regression analyses of survival data based on the Cox proportional hazard (PH) model were conducted on the time to event outcomes. Results: Between 2016-2022, 209 OS patients were seen at our center for initial diagnosis and treatment recommendations including 124 AYAs (59%). Amongst AYAs, 41 patients (median age 22y, range 14-38y) initiated and received the majority of their chemotherapy at our center and were included in analysis. Of the 41 AYAs, 17 were treated on MAP; 24 were treated using AP+. Ten patients &lt; 20 years received MAP; one patient &gt;30 years received MAP. The median time from initiation of therapy to surgery for those receiving MAP was 87.5 days vs 95.5 days for AP (p = 0.0052). Percent tumor necrosis varied widely with both regimens (range 0-99%) and was not statistically different (p = 0.11). There was no statistically significant difference in PFS between AYAs treated with MAP as compared to AP+ (Three-year PFS rates 80% vs 66%, p = 0.40). Evaluation of treatment related toxicity and late effects is ongoing. Conclusions: We had insufficient data to compare survival outcomes in this limited retrospective series. This limited retrospective study did not show a statistically significant difference in PFS for AYA patients with OS treated with a standard pediatric vs. adult type regimen containing at least 3-drug chemotherapy. Further study is needed to refine treatment for this patient population. These data support prospective efforts to harmonize AYA treatment paradigms in osteosarcoma.

Establishing the Top 10 Research Priorities for Adolescent and Young Adult (AYA) Cancer in Canada: A Protocol for a James Lind Alliance Priority Setting Partnership.

Adolescents and young adults (AYAs; 15-39 years) diagnosed with cancer have unique medical and psychosocial needs. These needs could be better addressed through research that is focused on the topics that matter most to them. However, there is currently no patient-oriented research agenda for AYA cancer in Canada. This manuscript describes the early development and project protocol for a priority-setting partnership (PSP) for establishing the top 10 research priorities for AYA cancer in Canada. This project follows the PSP methodology outlined by the James Lind Alliance (JLA) to engage patients, caregivers, and clinicians in research prioritization. The steps of a JLA PSP include establishing a steering group and project partners, gathering uncertainties, data processing and verifying uncertainties, interim priority setting, and a final priority setting workshop. The AYA cancer PSP will result in a top 10 list of research priorities identified by Canadian AYA patients, caregivers, and clinicians that will be published and shared broadly with the research community. The first steering group meeting was held in April 2023, and the project is ongoing. The establishment of a patient-oriented research agenda for AYA cancer will catalyze a long-term and impactful research focus and ultimately improve outcomes for AYA patients with cancer in Canada.

Association of HbA1C and comfort with diabetes self-management among adolescents and young adults with type 1 diabetes.

Adolescents and young adults (AYA) living with type 1 diabetes (T1D) are a vulnerable demographic at risk for sub-optimal glycemic outcomes at a time when they are taking over their diabetes management. The purposes of this study were to examine levels of self-reported comfort with diabetes management tasks among AYA living with T1D and to describe the relationships among comfort levels, sociodemographic factors, and HbA1c. During a routine diabetes care visit, AYA aged 15-23 years old living with T1D received a transition survey to self-assess their comfort level with different diabetesmanagement tasks. Among 161 participants who completed the survey (median age 17 years, median diabetes duration 7 years, 82.3% White, 40.9% female, 66.5% with private insurance, and median HbA1c 8.8%), comfort with diabetes management tasks was generally rated highly (median overall comfort level of 4.5 out of 5), irrespective of race or insurance type. Regression analysis revealed that higher self-reported comfort level with diabetes management tasks was associated with a higher HbA1c (p = 0.006), after controlling for age, sex, race, insurance type, and diabetes duration. These findings suggest that self-reported comfort with independently managing T1D may not be a sufficient metric in assessing AYA patients' need for further intervention to optimize glycemic outcomes as they transition from pediatric to adult diabetes care, and highlights the importance of continuity of care to support diabetes management during this transitional period.

Cutaneous melanoma in adolescents and young adults.

Cutaneous malignant melanoma (CMM) ranks among the five most common cancers in young people in high-income countries and it features peculiar clinicopathological traits. Very few studies have addressed the quality of care and the costs for adolescents and young adults (AYA) population. To provide a comprehensive epidemiological and clinicopathological profile of CMM in AYA. The study also addresses the cost-of-illness and the diagnostic-therapeutic performance indicators by patient age category. This population-based cohort study included 2435 incident CMM (age range 15-65 years; age 15-39 = 394; age 40-65 = 2041), as recorded in 2015, 2017 and 2019 by the Regional Veneto Cancer Registry (Italy). Cramer's-V tested the strength of association between pairs of variables. The Kaplan-Meier method was used to test the association between age and survival rate. The clinical performance indicators were computed using the Clopper-Pearson exact method. In AYA patients (16.2%), CMM incidence rates increased significantly from 1990 to 2019. Low-stage CMM (p = 0.007), radial growth pattern (p = 0.026) and lower Clark levels (p = 0.007) prevailed; males had less advanced malignancies (p = 0.003), with the trunk as the most common primary site (67.5%); the lower limbs (32.6%) were the most common primary site for females (p < 0.001). Overall survival was better in AYA than adults. No significant difference was detected in the clinical management of the two age groups, with the only exception of the margin in wide local excision. The care costs were lower in AYA (€195.99 vs. €258.94, p = 0.004). In AYA patients, the CMM clinicopathological presentation shows a distinctive profile. The present results provide critical information for optimizing primary and secondary prevention strategies and for tailoring diagnostic therapeutic procedures to the peculiar profile of AYA CMM patients.