The first study of treatment patterns for Australian adolescent and young adult (AYA) patients with acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) has found that most are receiving best practice care.
However, the review of medical records for 351 patients with ALL or AML aged 15-24 who received induction therapy at one of 47 hospitals across six states, did not show a significant effect between treatment protocol and survival.
The study found most patients (55-56%) were treated at an adult hospital with a focus on adolescents and young adults. About a quarter of patients (22-28%) were treated at other adult hospitals and up to 24% were treated at paediatric hospitals.
Typically, 15 and 16 year-olds were treated in paediatric facilities while 17-24 year-olds were treated in adult hospitals.
More intensive paediatric protocols were used in all patients with ALL attending paediatric hospitals and for most patients with ALL at adult hospitals (77%).
“Our data suggest that, at least by the late 2000s, most haematologists working at adult centres in Australia had incorporated the growing body of evidence for treating AYA ALL patients on paediatric protocols into their clinical practice,” the study authors wrote in the journal Pediatric Blood and Cancer.
Paediatric protocols were used in 86% of AML patients attending paediatric centres but never in any adult hospitals.
“This finding suggests that adult clinicians do not consider these more intensive protocols suitable for AML patients over the age of 18 or may be unaware of pediatric AML approaches,” the study authors said.
However they acknowledged there was ‘less clarity regarding whether adult or paediatric protocols are more appropriate for AYA AML patients’.
They found in both ALL and AML patients, adult treatment protocols were uniformly associated with poorer overall survival (OS), event-free survival (EFS), and relapse-free survival (RFS) than paediatric protocols but not at a statistically significant level.
“We found almost a halving of the hazard ratio associated with OS, and reductions between 33% and 40% for EFS and RFS, for ALL patients treated on pediatric-type protocols compared to those on an adult protocol.”
While most adolescent and young adult leukaemia patients in Australia were receiving best practice care, there was some room for improvement, the researchers concluded.
“The development of AYA services that cross pediatric and adult hospitals during our study period is also likely to have increased collaboration, support, and expertise in using pediatric protocols and managing any resulting side effects,” they added.
“A move toward network-wide clinical multidisciplinary team meetings to plan and oversee therapy during our study period may have also helped to ensure that all treatment centers have access to clinical expertise.”