Clinical Trial Enrolment In the Adolescent and Young Adult (AYA) Population with Hematologic Malignancies: A South Carolina (SC) Community Practice Perspective
Authors: Sullivan Jill , Jackson Jamie , Kristie Griffen , Eberly John , Davis Jennifer , Fanning Suzanne R. , Crosswell Hal E 
Published: October 2019

Abstract
Abstract 2577

Background:
Leukemias and lymphomas comprise 25% of all cancers in AYA patients age 15–39 years. Survival benefit from treatment advances has been less for AYA patients compared to the pediatric patients (<15 years of age). One reason for this disparity in survival is the relative lack of clinical trial accrual in AYA population. Previous population-based analysis of cooperative group participation between 1992 and 1997 found 71% of children under age 15 participated in clinical trials versus 24% of 15–19 year olds and less than 2% of 20–29 year olds (Liu et al., 2003). The majority of reports on this “AYA Gap” have been from large academic institutions or pooled national databases. We report our 5 year experience of clinical trial enrolment of AYA leukemias and lymphomas (L&L) from a SC community-based practice.

Methods:
We retrospectively analyzed the data on all patients, age 0–39 years, with newly diagnosed acute leukemias(ALL, AML) and lymphomas (Hodgkin {HL} and non-hodgkin lymphoma{NHL}) between 2005 and 2009 through the Greenville Memorial Hospital (GMH) and BI-LO Charities Children's Cancer Center (BCCCC) registries in Greenville SC. AYA was defined ages 15–39, with the pediatric ages <15 as the control. Demographic comparisons were made with available state-wide and SEER registry data. Clinical trial availability was abstracted from practice clinical research offices and NCI database using www.clinicaltrials.gov.

Results:
Among 684 total oncology patients 0–39 years of age, 528 were AYA. Median age was 33 for the total AYA population but 26 for the 76 patients with L&L (ALL = 14, AML = 7, HL = 27, NHL = 28); there was no difference between the pediatric and AYA populations in regards to other demographic characteristics (race, gender, insurance, or vital status). Leukemia and lymphoma patients age 15–39 represented a similar distribution (4.7% and 10.4% of total diagnosis, respectively) in comparison to statewide and SEER data. Leukemia accounted for 80% of pediatric diagnoses while lymphoma comprised the bulk (72%) of AYA diagnoses; this is similar to data observed nationally. Statewide clinical trials were available to 72% of pediatric patients and 60% of AYA patients; local clinical trial availability was higher in the pediatric population than the AYA population (94% versus 69%). Sixty-two percent of pediatric patients were actually enrolled on a clinical trial in comparison to only 17% of AYA patients. Only 21% of AYA were treated at a pediatric facility, as compared to 98% of pediatric patients. Clinical trial enrollment of AYA patients treated at a pediatric facility was 75% versus 3% of patients treated at an adult facility. For the 97% of AYA patients treated at an adult facility but not enrolled on a clinical trial, 55% of patients had a trial available to them locally (34%) or statewide (21%). When considering lymphoma alone, as the most prominent AYA diagnosis, the majority of HL (89%) and NHL (82%) patients were not enrolled on clinical trials; of those patients not enrolled on a clinical trial, only 30% and 22% of HL and NHL, respectively, had a clinical trial available to them locally.

Conclusion:
In a community-based adult and pediatric oncology practice, there is a significant discrepancy in the number of L&L patients enrolled on a clinical trial when comparing pediatric and AYA cohorts. AYA L&L patients fail to be enrolled on clinical trials due to lack of clinical trial availability as compared to the pediatric L&L population.

Disclosures:
No relevant conflicts of interest to declare.