ArticleCancer medicine2019
The effect of adopting pediatric protocols in adolescents and young adults with acute lymphoblastic leukemia in pediatric vs adult centers: An IMPACT Cohort study.
Article in Cancer medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- American Society of Hematology 2026 guidelines for frontline management of acute lymphoblastic leukemia in adolescents and young adults.Blood advances · 2026Guideline
- Pediatric-inspired regimens and HSCT for adolescents and young adults with acute lymphoblastic leukemia.Blood advances · 2026Pooled it
- The Requirements for Setting Up a Dedicated Structure for Adolescents and Young Adults with Cancer-A Systematic Review.Current oncology (Toronto, Ont.) · 2025Pooled it
- Pediatric-Inspired Regimens in the Treatment of Acute Lymphoblastic Leukemia in Adolescents and Young Adults: A Systematic Review.Current oncology (Toronto, Ont.) · 2023Pooled it
- Community Experience With Pediatric-Inspired Regimens for Acute Lymphoblastic Leukemia in Adolescent and Young Adults.Cancer medicine · 2026Article
- Survival Outcomes with Guideline-Concordant Pediatric-Inspired Regimens in Adolescent/Young Adult Acute Lymphoblastic Leukemia: Retrospective Real-World Analysis.Drugs - real world outcomes · 2026Article
- Evaluating Asparaginase Toxicity in Hispanic Patients With Acute Lymphoblastic Leukemia in a Large Safety-Net Hospital.World journal of oncology · 2025Article
- Adoptive Cellular Therapies in Pediatric Leukemia Patients After Allogeneic-Hematopoietic Stem Cell Transplants.Immune network · 2025Review
- Liver Cancer Mortality Rates in Peru: Trend Analysis from 2003 to 2017.Asian Pacific journal of cancer prevention : APJCP · 2025Article
- Article
- Augmented use of L-asparaginase markedly improves AYA ALL outcomes: FBMTG prospective MRD2014 study.Blood neoplasia · 2024Article
- Adolescents and young adults (AYAs) vs pediatric patients: survival, risks, and barriers to enrollment.Hematology. American Society of Hematology. Education Program · 2023Article
- Survival and predictors of mortality among acute leukemia patients on follow-up in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A 5-year retrospective cohort study.Cancer reports (Hoboken, N.J.) · 2023Article
- Big Kids or Little Adults? Acute Lung Injury Research in Adolescents and Young Adults.Annals of the American Thoracic Society · 2023Article
- Mortality trends and geographic distribution of kidney cancer in Peru: a secondary analysis.BMC urology · 2023Article
- Comparison of diagnostic and treatment processes among pediatric and adolescents and young adults' populations suffering from acute lymphoblastic leukemia and lymphomas.Frontiers in oncology · 2023Article
- Adolescent and young adult (AYA) oncology: A credentialed area of focused competence in Canada.Cancer medicine · 2023Review
- Updated Trends in Hematopoietic Cell Transplantation in the United States with an Additional Focus on Adolescent and Young Adult Transplantation Activity and Outcomes.Transplantation and cellular therapy · 2022Article
- An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL.Blood advances · 2021Article
- Review
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Authors and funding
7 authors.
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Abstract
backgroundRetrospective studies have shown adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) have superior survival when treated in pediatric versus adult centers (locus of care; LOC). Several adult centers recently adopted pediatric protocols. Whether this has narrowed LOC disparities in real-world settings is unknown.
methodsThe IMPACT Cohort is an Ontario population-based cohort that captured demographic, disease and treatment (treatment protocol, chemotherapy doses) data for all 15-21 year olds diagnosed with ALL 1992-2011. Cancer outcomes were determined by chart abstraction and linkage to provincial healthcare databases. Treatment protocols were classified as pediatric- or adult-based. We examined predictors of outcome, including LOC, protocol, disease biology, and time period.
resultsOf 271 patients, 152 (56%) received therapy at adult centers. 5-year event-free survival (EFS ± SE) among AYA at pediatric vs adult centers was 72% ± 4% vs 56% ± 4% (P = 0.03); 5-year overall survival (OS) was 82% ± 4% vs 64% ± 4% (P < 0.001). After adjustment, OS remained inferior at adult centers (hazard ratio 2.5; 95% confidence interval 1.1-6.1; P = 0.04). In the most recent period (2006-2011), 39/59 (66%) AYA treated at adult centers received pediatric protocols. These AYA had outcomes superior to the 20 AYA treated on adult protocols, but inferior to the 44 AYA treated at pediatric centers (EFS 72% ± 5% vs 60% ± 9% vs 81% ± 6%; P = 0.02; OS 77% ± 7% vs 65% ± 11% vs 91% ± 4%; P = 0.004). Induction deaths and treatment-related mortality did not vary by LOC.
conclusionsSurvival disparities between AYA with ALL treated in pediatric vs adult centers have persisted over time, partially attributable to incomplete adoption of pediatric protocols by adult centers. Although pediatric protocol use has improved survival, residual disparities remain, perhaps due to other differences in care between adult and pediatric centers.
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