Superior outcomes with paediatric protocols in adolescents and young adults with aggressive B‐cell non‐Hodgkin lymphoma. (1st October 2021)

• Record Type: Journal Article
• Authors: Gupta, Sumit; Alexander, Sarah; Pole, Jason D.; Sutradhar, Rinku; Crump, Michael; Nagamuthu, Chenthila; Baxter, Nancy N.; Nathan, Paul C.
• Is Part Of: British journal of haematology. Volume 196:Number 3(2022)
• Page Start: 743
• Page End: 752
• Publication Date: 2021-10-01
• Subjects: adolescents and young adults -- Burkitt lymphoma -- diffuse large B‐cell lymphoma -- population‐based -- survival; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.17862
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: Survival disparities by locus of care (LOC; paediatric versus adult) among adolescents and young adults (AYA) with acute lymphoblastic leukaemia (ALL) are well documented. Whether similar disparities exist among AYA with aggressive mature B‐cell non‐Hodgkin lymphoma (B‐NHL) is unknown. We identified all Ontario, Canada AYA aged 15–21 years at diagnosis of B‐NHL between 1992 and 2012. Demographic, disease, treatment and outcome data were chart abstracted. The impact of LOC on event‐free (EFS) and overall survival (OS) were determined, adjusted for patient and disease covariates. Among 176 AYA with B‐NHL, 62 (35·2%) received therapy at paediatric centres. The 5‐year EFS and OS [± standard error (SE)] for the overall cohort were 72·2 [3·4]% and 76·1 [3·2]% respectively. Both EFS and OS were superior among paediatric centre AYA [EFS (± SE) 82·2 (4·9)% vs. 66·7 (4·4)%, P = 0·02; OS 85·5 (4·5)% vs. 71·1 (4·3)%, P = 0·03]. Adjusted for histology, stage and time period, adult centre AYA had inferior EFS [hazard ratio (HR) 2·4, 95% confidence interval (CI) 1·1–4·9, P = 0·02] and OS (HR 2·5, 95% CI 1·1–5·7, P = 0·03). Sensitivity analyses restricted to the latest time period, when most adult centre AYA received rituximab, demonstrated similar disparities. Similar to AYA with ALL, AYA with B‐NHL may benefit from being treated with paediatric protocols. Studies prospectively validating these results are warranted.