Higher rates of leukemia relapse linked to clinical trial enrollment, access to continued care

Julie A. Wolfson, M.D.

According to a study published in Cancer Epidemiology, Biomarkers & Prevention, adolescents and young adults (AYA) ages 15-39 with acute lymphoblastic leukemia (ALL) are more likely to relapse than are their pediatric ALL counterparts ages 1-14, with contributing factors ranging from a lower rate of enrollment in available clinical trials to shorter durations of treatment.

Published by Julie A. Wolfson, M.D., MSHS, assistant professor and member of the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham and associate scientist in the Cancer Center Control and Population Sciences Program in UAB’s Comprehensive Cancer Center, the study looked at data from 184 patients ranging from ages 1-39 and treated for ALL at City of Hope Hospital from 1990-2010. The analysis covered relapse risk during therapy and after completing therapy for these populations.

In both cases of on-therapy and post-therapy relapses, AYA patients had an increased risk as compared to pediatric patients. Investigators were able to account for clinical factors, along with those related to health care delivery or treatment, including whether they were treated with a “pediatric-inspired” or “adult-style” regimen. Among AYA patients, they found patients had an increased risk of having a relapse while on therapy if they had not been enrolled on a clinical trial. They also found that AYA patients were more likely to relapse after completing therapy if they had received a shorter duration of maintenance or consolidation therapy.

“What this analysis reminds us is how unique this AYA population is, and how they continue to face challenges,” Wolfson said. “We recognize that often AYA patients are treated differently just depending on which hospital door they open. They are sometimes treated like pediatric patients, and at other times like adult patients. There are circumstances when this can affect their outcome, and we want to continue to identify factors that impact this group, the challenges they face and ways we can bridge the gap for AYA patients moving forward.”

As outlined in the study, health care delivery — meaning access to and enrollment in clinical trials — plays a role in the potential for relapse in AYA patients.

Wolfson explains that national guidelines encourage AYA patients with cancer to join a clinical trial whenever possible. The study’s findings support that recommendation, and although it is often challenging to find an open or appropriate study, national research groups are working to expand ways for AYA to participate.

“This, combined with the role of treatment factors such as duration of treatment in relapse of AYA patients, led us to suggest that more attention is needed on factors that inhibit AYA patients from seeking or continuing care, or from having access to innovative therapies,” Wolfson said. “The AYA age range is broad, but what is common among these patients is they are often at a place in life that poses unique challenges related to relapse, including being uninsured, under-insured or in a fragile socioeconomic place.”

Future studies will help researchers identify additional areas that need to be addressed in order to support long-term survival rates for AYA patients, as well as ways to maximize treatment options and retention.