Guideline-concordant treatment among adolescents and young adults with acute lymphoblastic leukemia.

Background: Individuals diagnosed with acute lymphoblastic leukemia (ALL) between 15-39yo (AYA: adolescents and young adults) face poor survival and unique challenges. We evaluated facility-level factors and guideline-concordant care (GCC) among AYAs with ALL at National Cancer Institute Community Oncology Research Program (NCORP) practices.

Methods: We assembled a retrospective cohort of 15-39yo AYAs with ALL treated at participating NCORPs between 2012-2016. NCORPs abstracted patient data and completed facility-level questionnaires for each clinical facility (CF: study-defined criteria). The central review committee adjudicated whether treatment was concordant with AYA-specific National Comprehensive Cancer Network ALL guidelines (ie, pediatric-inspired therapy or clinical trial). GCC was described by age, facility model (adult/internal medicine [adult/IM], pediatric, mixed [pediatric services within a general hospital]), and average annual AYA ALL volume. Generalized linear mixed effects models estimated the odds of GCC.

Results: AYAs receiving GCC were younger (n = 196, median = 19.5y) than those who did not (n = 31, median = 32.1y). GCC was observed in many 22-39yo (68.8%), and nearly universal in 15-21 y. In multivariable analyses, AYAs at adult/IM CFs had lower odds of GCC (OR = 0.02, 95% CI, 0.0-0.18); there was no statistically significant association between annual AYA ALL volume and receiving GCC. GCC was observed more often in adult/IM and/or mixed CFs with communication between adult/pediatric counterparts, AYA ALL Clinical Pathways, and/or AYA-specific meetings.

Conclusion: GCC among AYAs with ALL (specifically pediatric-inspired therapy) at NCORPs is associated with facility model (adult/IM), but not AYA ALL volume. Strategies to improve GCC could include facilitating communication and clinical pathways at adult/IM CFs treating AYA ALL.