Outcomes For Adolescents And Young Adults Research Articles

Comparison of Outcomes By Age of Patients with Limited Stage Hodgkin Lymphoma Treated with ABVD Alone; A Secondary Analysis of the Canadian Cancer Trial Group HD.6 Trial

Introduction: Management options for individuals with early-stage Hodgkin lymphoma (HL) include combined modality therapy (CMT), and chemotherapy alone. The HD.6 randomized phase III trial, in which ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) alone was compared with radiation based therapy, comprises the largest prospectively collected data set of individuals with limited stage HL treated with ABVD alone with long-term follow-up [Meyer JCO 2005, NEJM 2012]. Adolescents and young adults (AYAs) with cancer are considered a vulnerable population, in part due to unique psychosocial challenges and distinct disease biology. The most common cancer observed among AYAs is HL. However, studies focusing specifically on AYAs diagnosed with limited stage HL are scarce. We sought to evaluate the impact of age on outcomes of individuals with stage IA and IIA non-bulky HL, treated with ABVD alone.Methods: Individuals randomly assigned to ABVD chemotherapy alone on the HD.6 clinical trial formed the study population for this secondary analysis. The Kaplan-Meier life-table method was used to calculate the rates of overall survival (OS), event free survival (EFS) and freedom from disease progression (FFDP) defined as in the original trial. The primary analysis used univariate and multivariate Cox regression models with age included as a continuous variable. The following covariates were used in the multivariate analysis: age, gender, ECOG performance status (0-1 vs. ≥ 2), stage, erythrocyte sedimentation rate (ESR, < 50 vs. ≥ 50), number of nodal sites (< 4 vs. ≥ 4), white blood count, hemoglobin and lymphocyte count. Secondarily outcomes of AYAs, defined as those aged <30, and older adults aged >30 years old were compared with the use of the log-rank test for time to event endpoints and Chi-squared test for response rates, acute toxicity and chemotherapy administration. All analyses were based on the locked data base of July 15, 2011.Results: Of 196 eligible patients assigned to ABVD alone, median age was 34 years (range 17 to 68), 106 (54%) were male and 76 (38.8%) were <30 years of age. Nodular sclerosing histology was more common in those < 30 (77.6% vs. 68.0%) while mixed cellularity was more common in the cohort ≥ 30 (23.3% vs. 17.1%).The median length of follow-up was 11 years. Univariate analysis of age as continuous variable was statistically significant for OS (HR 1.09; 95% CI 1.04 to 1.14; p = 0.0001) and EFS (HR 1.04; 95% CI 1.02 to 1.07; p = 0.0017) but not for FFDP (HR 1.02; 95% CI 0.99 to 1.05; p = 0.22) The significance of age as a continuous variable for OS and EFS was confirmed in the multivariate analysis (HR 1.09; 95% CI 1.04 to 1.14; p = 0.0001, and HR 1.03; 95% CI, 1.01 to 1.06; p = 0.007 respectively). When comparing those aged < 30 with those aged ≥ 30 years, there was no statistical difference in 12 year OS (96% vs. 93%; HR 1.89; 95% CI 0.51 to 7.01; p = 0.32), EFS (89% vs. 83%, HR 1.63; 95% CI 0.72 to 3.68; p = 0.23) or FFDP (89% vs. 86%, HR 1.23; 95% CI 0.52 to 2.87; p = 0.63). All three deaths (100%) in those under 30 were due to Hodgkin lymphoma (two disease progression and one non-protocol treatment complications). In those over 30 only three (33.3%) of the nine deaths were attributed to HL (one disease progression, one early treatment related toxicity and one non-protocol treatment complication); the remainder were due to second malignancy (4) and cardiovascular disease (2). The majority of deaths (8/12, 67%) occurred in those > 60 years at study enrolment and > 65 years at death. There was no statistical difference in overall response rates (62/76, 81.6% vs. 97/120 80.8%), acute grade 3 and 4 toxicities, or chemotherapy administration between those aged under 30, or over 30 years.Conclusions : In this randomized phase III trial of individuals with limited stage Hodgkin lymphoma, clinical outcomes of AYAs were comparable with those of adults in middle age. However, deaths were most prominent in older patients > 60 years at the time of diagnosis and predominantly from causes other than Hodgkin lymphoma, explaining the impact of age as a continuous variable on survival but not disease progression. DisclosuresWinter:Merck: Research Funding; Glaxo-Smith-Kline: Research Funding. Hay:Celgene: Research Funding; Roche: Research Funding; Abbvie: Research Funding; Kite: Research Funding; Amgen: Research Funding; Janssen: Research Funding; Novartis: Research Funding.

Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary Hospital in Kenya

Background: Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure.&#x0D; Objective: To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya.&#x0D; Methodology: A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet.&#x0D; Results: A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load &lt;1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load &gt; 1000 copies/ ml p&lt;0.012.&#x0D; Conclusion: The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years).&#x0D; Keywords: Adolescents; HIV; Kenya; virologic suppression; young adults.

Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary hospital in Kenya.

Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure. To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya. A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet. A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load <1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load > 1000 copies/ml p<0.012. The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years).

Defining patient-elicited concepts unique to adolescents and young adults with cancer.

12118 Background: Adolescents and young adults (AYAs) require a multidisciplinary approach to cancer care due to complex biopsychosocial variables and varied developmental maturity. Currently, age and diagnosis determine referral to pediatric or adult oncology with differing care paradigms and service utilization. These issues, in conjunction with differences in tumor biology and lower accrual to clinical trials, have contributed to marginal improvements in outcomes for AYAs. Compounding this dilemma is a lack of validated patient-reported outcome measures (PROs) for AYAs. Tracking standardized PROs longitudinally is a crucial step in understanding psychosocial variables, identifying tailored needs, improving outcomes and standardizing care. However, developing a PRO tool for AYAs first requires identifying AYA-unique domains. Methods: Three, 90-minute focus groups were conducted with AYAs treated at Memorial Sloan Kettering in the context of 1) pediatric oncology, 2) medical oncology, and 3) either service. Topics explored included: experiences of cancer care as an AYA; physical, social and emotional concerns; and information needs, including appropriateness, timing, and depth of information. Thematic content analysis of transcripts was performed by four interdisciplinary coders in weekly iterative consensus rounds. Phase one consisted of identification of key domains to guide line-by-line coding with NVivo software. Phase two consisted of independent review and categorization of codes, followed by three successive consensus meetings to identify distinct themes. Results: A mean of 6 patients (range 5-7) participated in each of the 3 groups; the total sample (n = 17) included 9 males and 8 females, ages 19-35 years (median 26). Four AYA-unique themes were identified: 1. AYAs have an uncertain sense of the future and desire more engagement in conversations pertaining to survivorship, long-term effects and transition to outpatient life. 2. Cancer as an AYA is a socially-isolating experience, prompting a strong desire to connect with peers during and post-treatment. 3. AYAs want control over who can be present during discussions with their care team as the presence of loved ones can impede or facilitate communication. 4. AYAs may be living far away from loved ones during treatment and lack supports needed to help them navigate treatment and daily life. Conclusions: Concept elicitation via focus groups identified novel themes related to survivorship, isolation, communication and social support, which can inform development of AYA-specific PROs.

Change of clinical features and outcomes of adolescents and young adults (AYA) with colorectal cancer over time: Pooled analysis of 26,768 patients in the National Cancer Database (NCDB).

256 Background: The incidence of colorectal cancer (CRC) in younger patients (pts) is rising. The underlying etiology is unknown, and it is uncertain if disease biology and clinical features are changing over time. Methods: A retrospective study of pts data in the NCDB was performed to compare the clinicopathological features and outcomes of AYA with CRC over a 12-year period. Pts diagnosis period was dichotomized into older (2004 – 2009) and newer (2010 – 2015) eras. Uni- and multi-variable chi-square, logistic regression, and survival analyses were used for comparisons. Survival differences were assessed using Kaplan-Meier curves. Results: In total, 26,768 AYA (18-40yrs) with CRC were identified and included in the analysis: 45.8% (n = 12,268) from the older and 54.2% (n = 14,500) from the newer era. There were no differences between the 2 groups in gender distribution or levels of income and education. However, in the newer vs. older era, there was a greater proportion of non-white, non-black pts (7.2% vs. 6%; p = 0.0005) and pts diagnosed between the ages of 18-30 (21.1% vs. 18.8%; p &lt; .0001). Pts in the newer era tended to have more comorbidities (8.6 vs 7.5%; p = 0.0012), left-sided tumors (77.5% vs. 76.1%; p = 0.04), and well-differentiated histology (12.0% vs. 8.3%; p &lt; 0.0001). Newer era pts also had lower rates of metastatic disease at presentation (15.3% vs. 18.2%; p &lt; 0.001%) and nodal involvement (54.9 vs. 58.4%; p &lt; 0.001%). Median OS of pts with stage IV disease appears to have improved over time (24.1 vs. 22.5 mos; p = 0.014). After controlling for age, race, primary tumor site and grade, presence of comorbidities, and health insurance status, older era pts with stage IV CRC were at a 15.1% greater risk of all-cause death by year 5 compared to newer era pts (HRadj= 1.15 (1.07-1.24, p = 0.0001). Conclusions: Our data suggest that AYA with CRC in more recent years tend to present at a younger age and have a lower rate of metastatic disease. They also have improved survival. Further investigation of AYA disease etiology and biology are warranted. Continued efforts to increase awareness, promote early detection, and improve treatment options are essential.

Cord Blood Transplantation in Adolescents and Young Adults with Acute Leukemia: On Behalf of Eurocord, Ctiwp and PDWP of EBMT

▪Outcomes for adolescents and young adults (AYA) might be considerably different from children and older adults with acute leukemia (AL). Patients in this transitory period tend to be considered at higher risk for poorer outcomes. However, AYA is still underrepresented in most hematopoietic stem cell transplant (HSCT) studies. Recent evidence shows superior outcomes for AYA with acute lymphoblastic leukemia (ALL) using pediatric rather than adult first line chemotherapy regimens. The aim of this study is to analyze outcomes of umbilical cord blood transplant (UCBT) in AYA patients with ALL or acute myeloid leukemia (AML) after myeloablative conditioning regimen (MAC).Eligibility criteria included patients with AL aged 15-25 (median 19) years, transplanted between 2004 and 2016 in EBMT centers, with single or double UCBT as first allogenic transplantation after MAC regimen and reported to Eurocord. A total of 504 patients were included. Primary endpoint was overall survival (OS).Median follow-up for survivors was 38 months (1 month-11 years). Median time from diagnosis to UCBT was 11 months (1 month-17 years) (interquartile range 5-29 months). Diagnosis was ALL in 59% (n=297) and AML in 41% (n=207); 64% of patients were male. Disease status at UCBT were 42% in 1st complete remission (CR) (n=203), 2nd CR in 38% (n=183), and advanced disease in 20% (n=96).Fifty eight percent of patients (n=293) received single and 42% (n=211) double UCBT. Cyclophosphamide + TBI ± fludarabine (45%) was the most frequently used conditioning regimen. Anti-thymoglobulin (ATG) was used in 54% and GVHD prophylaxis was cyclosporine A + mycophenolate mofetil in 44% of patients. Median nucleated cell dose at collection was 3.63 (range 0.9-9.0) X107/Kg for single and 5.25 (range 2.3-10.6) X107/Kg for double UCBT.The 3-year OS was 45±2%; 3-year leukemia free survival (LFS) was 41±2% and refined GVHD free/relapse free survival (rGRFS) was 32±2%.OS was similar in ALL and AML (45±3% vs 45±4%, p-value=0.69). According to disease status at UCBT, 3-year OS was 54±4% for patients in CR1, 48±4% for CR2 and 20±4% for advanced disease (p-value<0.001).Cumulative incidence function (CIF) for neutrophil engraftment at day-60 was 88% [95% confidential interval (CI) 85-90] in a median time of 24 days. CIF of acute GVHD grade II-IV at day-100 was 28% (95%CI 24-32) and out of the 233 patients with aGVHD, 73 (21%) had grade III-IV.The 1-year CIF of chronic GVHD was also 28% (95%CI 24-33) and out of the 124 patients with cGVHD, 52 (42%) had the extensive form.The 3-year CIF of transplant related mortality (TRM) was 31% (95%CI 24-33). The 3-year CIF of relapse was 28% (95%CI 24-32), and according to disease status at UCBT, relapse was 28% (95%CI 21-34) for patients in CR1, 24% (95%CI 18-31) for those in CR2 and 37% (95%CI 27-47) for advanced disease.Main causes of death were relapse (41%) and TRM (57%, mainly infections and GVHD).In multivariate analysis, disease remission at UCBT (HR 0.46, 95%CI 0.32-0.66, p-value<0.001) and transplant performed in more recent years (HR 0.75, 95%CI 0.62-0.90, p-value=0.002) were independently associated with increased OS. A similar effect was observed for LFS (recent transplantation: HR 0.80, 95%CI 0.66-0.95, p-value =0.01 and disease remission: HR 0.51, 95%CI 0.36-0.72, p-value <0.001). On the other hand, negative CMV serology (HR 0.77, 95%CI 0.61-0.99, p-value =0.042), recent transplantation (HR 0.85, 95%CI 0.73-0.99, p-value=0.49) and disease remission (HR 0.61, 95%CI 0.44-0.84, p-value =0.002) were significantly associated with increased rGRFS. For grade II-VI aGVHD, ATG use (HR 0.52, 95%CI 0.32-0.82, p-value=0.005), single UCBT (HR 0.63, 95%CI 0.42-0.96, p-value=0.03), and recent transplant (HR 0.76, 95%CI 0.59-0.98, p-value=0.034) reduced the risk. However, no factor was associated to cGVHD.This large series of AYA patients with AL provides detailed information on UCBT for this particular cohort with results comparable with other sources of HSCT.Due to the lack of information on pre-transplant chemotherapy (pediatric versus adult protocols), we were unable to evaluate its effect on outcomes. Nevertheless, this study contributes to a better understanding of HSCT for an age group that is not thoroughly described in most publications. Demonstrating the feasibility of UCBT in AYA patients is important to facilitate the decision of stem cell source selection when a more standard donor is not available. DisclosuresHough:University College London Hospital's NHS Foundation Trust: Employment. Angelucci:Vertex Pharmaceuticals Incorporated (MA) and CRISPR CAS9 Therapeutics AG (CH): Other: Chair DMC; Celgene: Honoraria, Other: Chair DMC; Jazz Pharmaceuticals Italy: Other: Local ( national) advisory board; Novartis: Honoraria, Other: Chair Steering Comiittee TELESTO Protocol; Roche Italy: Other: Local (national) advisory board. Bader:Medac: Patents & Royalties, Research Funding; Neovii: Research Funding; Riemser: Research Funding; Cellgene: Consultancy; Novartis: Consultancy, Speakers Bureau.

Understanding care and outcomes in adolescents and young adult with Cancer: A review of the AYA HOPE study.

Historically, adolescents and young adults (AYA) diagnosed with cancer have been an understudied population, and their unique care experiences, needs, and outcomes were not well understood. Thus, 10 years ago, the National Cancer Institute supported the fielding of the Adolescent and Young Adult Health Outcomes and Patient Experiences (AYA HOPE) study to address this gap. We recruited individuals diagnosed at ages 15 to 39 with germ cell, Hodgkin and non-Hodgkin lymphoma, acute lymphoblastic leukemia, and sarcoma from Surveillance, Epidemiology, and End Results cancer registries into the first multicenter population-based study of medical care, physical, and mental health outcomes for AYAs with cancer in the United States. This review of the 17 published manuscripts showed low awareness of clinical trials and substantial impact of cancer on financial burden, education and work, relationships and family planning, and physical and mental health. It highlights the feasibility of a longitudinal population-based study and key lessons learned for research on AYAs with cancer in and beyond the United States.

Young Adult Counselors with Diabetes at Diabetes Camps: The Effect of Being a Peer Mentor on Counselors’ Health Behavior

Adolescents and young adults (AYA) with type I diabetes (T1D) often struggle with illness management. Although diabetes camps have been shown to improve blood sugar control among campers, the effect of the camp experience on counselors’ diabetes self-management has never been studied. In addition to the camp environment, it was hypothesized that peer factors among counselors, such as diabetes role modeling, would positively influence diabetes self-care behaviors and that counselors would be able to select diabetes role models based on these appropriate self-management behaviors. Counselors with T1D working at 2 summer camps were recruited to participate. Participants completed questionnaires including the Diabetes Behavior Rate Scale (DBRS) and a peer-assessment form in which participants were asked to nominate friends and diabetes role models, and to assign a role model score for each counselor. Hemoglobin A1C (HbA1c), a measure of blood sugar control, was obtained pre- and post-camp. Thirty-three participants completed the study. The average HbA1c score decreased 0.4% (p &lt; .01) over the 6 to 10 weeks of camp indicating improved metabolic control at camp. The number of nominations for diabetes role model was associated with diabetes self-care (r = 0.351, p = 0.027). Diabetes role model scores were not associated with diabetes self-care (r = 0.272, p = 0.074). There was no correlation between HbA1c and diabetes self-care. The findings suggest that the camp counselor role is a potential target for intervention to promote positive outcomes for AYA with T1D. Lessons learned from how AYA with diabetes support one another at camp can be applied to community-based interventions for youth with T1D or other chronic illnesses.

Acute myeloid leukemia in adolescents and young adults: from the viewpoint of pediatricians.

It is well known that adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) should be treated based on pediatric ALL protocol, which could yield better survival rates. However, an optimal treatment strategy for AYAs with acute myeloid leukemia (AML) is not yet established and corresponding data are limited. Compared with ALL, clinical and biological characteristics of pediatric and adult AML are relatively similar. Moreover, treatment strategy is quite similar, although pediatric protocols are more intensive and transplant indications are narrower. Previous reports show that AYAs with AML have similar to relatively lower survival rates and higher treatment-related mortality than children with AML. These results indicated that intensive pediatric chemotherapy is effective for preventing AML relapse in AYAs but higher toxicity rates compensates overall survival. To improve the outcomes of AYAs with AML, it is essential to develop optimal intensive chemotherapy, introduce novel targeted therapies, and adopt better risk stratification, particularly to determine appropriate transplant indications. These strategies should be accomplished by close cooperation between pediatric hematologists/oncologists and adult hematologists.

Pilot of the Chronic Disease Self-Management Program for Adolescents and Young Adults With Sickle Cell Disease

PurposeThis study evaluated the feasibility of a group self-management intervention, the well-established Stanford Chronic Disease Self-Management Program (CDSMP), for adolescents and young adults (AYA) with sickle cell disease (SCD). MethodsA total of 22 AYA participants with SCD, ages 16–24 years, completed self-efficacy and quality of life measures before the CDSMP, after, and 3 and 6 months later. ResultsThis AYA cohort showed significant improvements in self-efficacy (primary outcome) after the intervention. Analyses of follow-up data revealed a medium effect of the CDSMP on patient activation 3 months post although this was not sustained. Participants were highly satisfied, but only 64% completed the program. ConclusionsThis study demonstrates that the CDSMP is acceptable and has the ability to improve self-efficacy. Additional research is needed to determine feasibility and evaluate health outcomes for AYA with SCD.

Outcome of Adolescents and Young Adults Compared With Pediatric Patients With Acute Myeloid and Promyelocytic Leukemia.

Studies on the outcome of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) and acute promyelocytic leukemia (APL) are limited. We compared the outcome of AYA (19-30 years) patients with AML and PML and pediatric (0-18 years) patients with AML (pAMLs) and APL (pAPLs) utilizing the Surveillance Epidemiology and End Results-18 registry. Early mortality rate (EMR), defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment-related mortality. Survival statistics were computed using the Kaplan-Meier method. Multivariate analysis was done using logistic regression and the Cox proportional hazard regression model. A total of 6343 patients with AML were identified; 44.7% were AYAs. pAMLs had lower EMR (6.2% vs. 9.2%; P< .01) and higher overall survival (OS) (1-year, 70.3% vs. 62.1%; 5-year, 48.2% vs. 36.4%; P< .01). Nine hundred twenty patients with APL were also identified; 59.5% were AYAs. No statistically significant difference was found between AYAs with APL and pAPLs in EMR (11.4% vs. 14.1%; P= .23) and OS (1-year, 83.8% vs. 81.2%; P= .31 and 5-year, 68.2% vs. 73.1%; P= .11]. Comparing all patients with AML and APL, AYAs with APL and pAPLs had higher EMR (11.4% and 14.1% vs. 6.2% and 9.2%; P≤ .01) but better OS than AYAs with AML and pAMLs (5-year OS, 68.2% and 73.1% vs. 48.2% and 36.4%; P≤ .01). Our analysis shows AYAs with AML have worse EMR and OS compared with pAMLs. AYAs with APL and pAPLs have similar outcomes. To our knowledge, this is the first study reporting outcomes of AYAs with APL and pAPLs using a large population-based registry and their comparison with same age patients with AML.

Outcomes of adolescents and young adults (AYAs) compared to pediatric patients with acute myeloid leukemia (AML) and acute promyelocytic leukemia (APL): Real world data from the SEER registry.

e18506Background: Studies on outcomes of AYAs with AML and APL are limited. We sought to compare outcomes of AYAs and pediatric patients (pts) with AML (pAML) and APL (pAPL) using the Surveillance ...

Outcome of Adolescents and Young Adults with Acute Myeloid Leukemia (AML) As Compared to Pediatric AML Patients: Real World Data from SEER Registry

Background: Limited data exists regarding the characteristics and outcomes of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) which are largely under-represented in both pediatric and adult trials. We sought to compare the characteristics and outcomes of AYAs with AML using a large population based registry in the United States.Methods: We utilized Surveillance Epidemiology and End Results (SEER)-18 registry to identify all pediatric (0-18 years) and AYA (age 19-30 years) patients diagnosed with AML using appropriate histology codes based on the International Classification of Diseases for Oncology, 3rd version. Patients with acute promyelocytic leukemia (APL) were excluded from all analysis. Survival statistics were computed for each group using actuarial (Kaplan-Meier method) and compared using Z test for comparison of population proportions. Early mortality, defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment related mortality. Kaplan Meier survival curves were plotted and compared using log-rank test. Multivariate analysis was done using logistic regression and Cox proportional hazard regression model. All p values were two sided and the level of significance was chosen at 0.05.Results: A total of 6343 eligible patients were identified, which comprised 2836 (44.7%) AYAs. A total of 52% (n=3346) were males, whereas 76%(n=4825) were whites. Histologically, majority of patients (56%; n=3545) were categorized as AML, not otherwise specified, followed by acute monocytic leukemia (9.9%, n=630). Majority (55%; n-3509) of the patients were diagnosed between 2001-2012. The early mortality rate was lower in the pediatric AML patients (pAML) as compared to AYAs (6.2% vs 9.2%; p<0.01). Similarly the 1 year (70.3% versus 62.1%; p <0.01) and 5 year (48.2% vs 36.4%; p<0.01) was higher in pediatric patients as compared to AYAs. Kaplan Meier plot showed worse overall survival of AYAs compared to pAMLs (Figure 1; p value of log rank <0.01). Multivariate logistic regression showed higher early mortality among AYAs as compared to pAML patients (OR 1.48; 95% CI 1.23-1.79; p<0.01). Similarly Cox regression showed worse overall survival among AYAs as compared to pAML (HR 1.34; 95% CI 1.26-1.44; p <0.01)Conclusions: Our population based analysis shows worse overall survival among AYAs as compared to pAML patients. Future clinical trials specifically focused on this age group are warranted to establish appropriate treatment regimens in this population. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Toxicity of Cancer Therapy in Adolescents and Young Adults (AYAs)

To identify treatment-related toxicities that are either more frequent or more severe in the adolescent and young adult (AYA) oncology population. To explore differences in drug pharmacology and patient physiology that contribute to toxicities in the AYA population and to describe the impact of treatment-related toxicities on outcomes for AYA patients. A PubMed search was undertaken using the key words Adolescent Young Adult Oncology, AYA, toxicity, bone marrow transplant, late effects, and chemotherapy. Additional toxicity information was also obtained from recent publications from cancer cooperative groups treating AYA patients. AYA patients often experience more severe toxicities than children when treated with identical chemotherapy regimens, which can interfere with successful administration of planned treatment, as well as have profound effects on quality of life. AYA patients with cancer face the dual challenge of disease biology associated with inferior response to treatment, thus necessitating treatment intensification, while at the same time suffering higher rates of specific toxicities such as vincristine-induced neuropathy, osteonecrosis, and treatment-related mortality caused by infection. AYA patients are at a higher risk for toxicities from regimens that may be tolerated by younger patients. Staff should be aware of toxicities facing this population so that appropriate supportive care measures can be utilized. Future research on the pharmacology of drugs in adolescence, hormonal effects on drug-metabolizing enzymes, cumulative exposure to different drugs in combination, and risk and severity of specific toxicities will be critical to improving the treatment of AYA patients.

Influence of insurance and marital status on outcomes of adolescents and young adults with acute lymphoblastic leukemia.

Although outcomes for adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) are worse when treated according to adult rather than pediatric protocols, one criticism is that this may be due to the emancipation of young adults. Using case listing session of Surveillance, Epidemiology, and End Results (SEER) 18 (1973-2010), we examined outcomes for AYA with ALL defined similar to Cancer and Leukemia Group B (CALGB) 10,403 criteria (age 18-30) predicated on marital and insurance status as surrogates for emancipation (limiting analysis to 2007-2010). Analyses were conducted with SEER*Stat 8.1.2, Microsoft Excel 2007, and GraphPad Prism 6. Comparisons were made by the Fisher exact test and log rank test (Mantel-Cox); all P values were 2-sided. Although age (24 and younger vs. 25 and older) was predictive of median overall survival (OS) (not reached vs. 33; P = .0029) (3-year OS 66% vs. 49%), social factors were not. Three-year OS for insured versus uninsured patients was 61% versus 50%, and median OS was not reached versus 30 months (P = .2334). Three-year OS for single versus married patients was 62% versus 55%, with median OS not reached for both groups (P = .1084). Insurance status and marriage did not influence outcomes for AYA with ALL, suggesting that intrinsic differences in disease and disease-specific therapies are more important than social issues.

Social connectivity and outcomes for adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL).

7049 Background: While the outcomes for AYAs with ALL are worse when treated on adult rather than pediatric protocols, one criticism is that this may be due to “emancipation” of young adults. Metho...

Survival Improvements Following Myeloablative Allogeneic Hematopoietic Cell Transplantation For Acute Lymphoblastic Leukemia In Adolescents and Young Adults Have Been Comparable To Younger Children: A Study From The Cibmtr

Adolescents and young adults (AYAs) with cancer have not experienced survival improvements over time to the same extent as younger and older patients. Studies in acute lymphoblastic leukemia (ALL) have identified differences in chemotherapy treatment approaches, adherence and possibly outcomes for AYAs treated in pediatric vs. adult settings. To determine if these same issues are operative in ALL patients treated with hematopoietic cell transplantation (HCT), we compared outcomes among 2730 patients including 1008 children (<15 years), 1244 AYAs (15-40 years) and 478 older adults (> 40 years) receiving myeloablative allogeneic HCT for ALL at US centers over three time periods (1990-1995, 1996-2001, and 2002-2007). All patients were in first or second complete remission at HCT; Ph+ patients were included; umbilical cord blood transplant recipients were excluded. The proportions of patients receiving peripheral blood transplants and receiving HCT using well-matched unrelated donors increased over time in all three age groups. From 1996-2001 to 2002-2007, transplant volume increased by 7% in children, 50% in AYAs, and 180% in older adults. Our analysis demonstrated that 5-year overall survival varied inversely with age group, but survival for AYAs over time improved at rates comparable to survival in children (Figure). Multivariate analyses adjusting for important patient and disease characteristics confirmed that older age was associated with poorer survival (hazard ratio 2.2 for older adults and 1.7 for AYA vs. children, P<0.001); however, no significant interactions were observed between age and time period confirming that changes in survival rates over time were similar between the groups even after statistical adjustment for other factors. Similar findings were observed for transplant-related mortality (TRM) and relapse. Transplantation techniques and outcomes were also explored for a subset of 131 AYAs (ages 15-25) transplanted at 46 pediatric or 92 adult centers. Although limited by small numbers, univariate analyses did not show differences in probabilities of overall survival, TRM, or relapse by center type. Patients transplanted at pediatric centers had a longer time from diagnosis to transplant than patients transplanted at adult centers (p=0.024), and were more likely to receive bone marrow vs. peripheral blood stem cell graft (p<0.001). Conditioning regimens (p=0.04) and GVHD prophylaxis (p<0.01) also differed. Taken together, these findings suggest that, in contrast to what has been observed for other cancers over time, survival following myeloablative allogeneic HCT for AYA's has improved at a rate comparable to other age groups. There appear to be differences in transplant timing and techniques for AYAs depending on whether treatment occurs in a pediatric or adult center but transplant outcomes did not significantly differ, in contrast to survival differences reported in the non-transplant setting. In summary, AYAs are experiencing improvements comparable with younger children, and appear to have similar outcomes whether transplanted at pediatric or adult centers. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Acute lymphoblastic leukemia in young adults

Acute lymphoblastic leukemia (ALL) is the most common and one of the most curable malignancies in children; however, it presents unique challenges in adolescents and young adults (AYAs). The purpose of this review is to discuss factors that contribute to the outcome disparities in AYAs with ALL as well as approaches that can be taken to optimize the care of this patient population. AYAs with ALL are unique and have outcomes that have lagged behind those observed in children with ALL. Contributing factors to the challenges faced by this group include distinctive disease biology, different drug pharmacology and toxicity profiles, and complex psychosocial and socioeconomic factors. Several clinical trials conducted worldwide have demonstrated that treatment with pediatric protocols significantly improves outcomes in the AYA population. Initiatives to improve outcomes for AYAs with ALL include treatment with pediatric regimens tailored to be delivered without excessive toxicity and in centers with the necessary supportive care and medical services to address the specific needs of this population. As more is understood about the unique disease biology of AYA ALL, targeted therapeutic approaches may offer promise for the future.

Treating the younger adult with acute lymphoblastic leukemia

SUMMARY The past decade has witnessed an increasing awareness of older adolescents and young adults (AYAs) with acute lymphoblastic leukemia as a distinct group of patients, with outcomes historically inferior to those of younger children. Retrospective comparison studies of AYAs treated on pediatric or adult clinical trials have demonstrated significantly improved outcomes for AYAs treated in pediatric trials. These findings have spurred international interest in prospectively evaluating pediatric regimens in young adults, and early results from several of these trials are encouraging. Additional study dedicated to the leukemia biology and psychosocial factors unique to the AYA patient will add further insight and hopefully improve outcomes for AYAs with acute lymphoblastic leukemia.

Outcome of Adolescents and Young Adults (AYAs) with Non-M3 Acute Myeloid Leukemia (AML) Treated on Children's Oncology Group (COG) Trials Compared to Cancer and Leukemia Group B (CALGB) and Southwest Oncology Group (SWOG) Trials

AbstractAbstract 183Acute Myeloid Leukemia - Therapy, excluding Transplantation: Pediatric and Adult AML TherapyAYAs with acute lymphoblastic leukemia have superior survival when treated with intensive pediatric regimens compared to regimens used for older adults. To determine if a similar benefit occurred in AYAs with AML, we performed a retrospective analysis of 517 patients (pts) with AML ages 16 to 21 years (yrs), comparing outcomes between patients treated on COG (n=281), CALGB (n=149) and SWOG (n=87) studies from 1986 to 2008. We also performed stratified analyses, comparing younger to older patients (16-18 vs 19–21 yrs) and comparing early and later studies. Early studies included those before 1996 (COG: 2861, 2891; CALGB: 8525, 9022, 9222, SWOG 8600). Later studies included COG 2941, 2961 and AML03P1, CALGB 9621, 19808 and SWOG 9500 and S0106.The median age was 18.0 yrs. However, the COG cohort (17.2 yrs) was significantly younger than CALGB (20.1 yrs) and SWOG (19.8 yrs) (p<0.001); 94% of COG pts were <19 yrs. The median white blood cell count, percent bone marrow blasts, FAB classification and overall complete remission rates did not differ between the Groups. The analysis of cytogenetics is ongoing as we reconcile differences between varying cooperative group classification systems. Assessment of the cumulative incidence of relapse is ongoing as well. Data on molecular abnormalities were incomplete and not analyzed.At eight years from the time of study entry, overall survival (OS) was first noted to be significantly higher for the COG cohort than for the combined CALGB/SWOG cohort (45+6% vs. 36+7%) (p<0.001). Combining the patients from the three cooperative groups, the OS in younger AYAs was 43±6% vs 32±8% in older AYAs at 10 yrs (p<0.05). Within each cooperative group, there was no difference in the OS of younger and older AYAs. Combining the patients from the three cooperative groups, the 5 yr OS improved from 38+6% in early studies to 48+6% for AYAs on later studies (p=0.045).Data on all patients from the 3 cooperative groups showed younger AYAs had a higher 5 yr EFS than older AYAs (37%+5% vs 26%+7% (p=0.015). Younger AYAs in COG had improved EFS compared to older AYAs in COG (39%+6% vs 17%+18%)(p=0.053). There was no significant difference in EFS between younger and older AYAs in CALGB or SWOG, where EFS was 28%+8% vs 27%+10%, respectively. Overall, the 5 year EFS of the COG AYAs (38%+6%) was higher than CALGB and SWOG combined (27%+6%) (p=0.006), although the younger age of the COG cohort is confounding. Combining the data from the 3 cooperative groups, 5 yr EFS has improved from 30+6% in earlier studies to 36+6% in later studies (p=0.039).One marked distinction between the cooperative groups was the significantly higher treatment-related mortality (TRM) on COG trials. TRM was 29 + 5% at 5 yrs on COG trials compared to 7 + 4% for CALGB and SWOG patients combined (p<0.001). Changes to supportive care guidelines in COG AML trials in 2000 have subsequently led to a decrease in TRM. Combining pts from all 3 cooperative groups, younger AYAs had increased 5 yr TRM of 25+5% compared to 8+4% of older AYAs (p<0.001). However, there were no differences in TRM between younger and older AYAs within each cooperative group, which may be due to the younger age of the COG cohort. Overall, 5 yr TRM has increased from 13+4% on early studies to 24+5% on later studies.In summary, younger AYAs have improved OS and 5 yr EFS in comparison to older AYAs. Age is a confounding variable in this cohort making it difficult to compare outcomes for AYAs treated on pediatric and adult studies. Even within the small 6-year age span of these AYAs, there are marked differences in the ages of patients treated by pediatric and adult cooperative groups. OS and EFS have increased for AYAs in more recent studies; unfortunately TRM has increased as well. Disclosures:No relevant conflicts of interest to declare. [Display omitted]