ASH 2025: Association Between Adolescent and Young Adult (AYA) Age, Acuity of Illness at Diagnosis, and Clinical Trial Enrollment Among Patients with Hematologic Malignancies at a Pediatric Center

Clinical trials represent an important opportunity to access cutting edge therapies in hematologic malignancies. In general, adolescents and young adults (AYA) with blood cancers have worse survival outcomes compared with their younger counterparts, which may be related to clinical trial participation. In this study, led by Foundation Scientific Advisory Board (SAB) Member Sharon Castellino, MD, MSc of Winship Cancer Institute, researchers investigated potential factors associated with clinical trial enrollment among pediatric and AYA patients with hematologic malignancies treated at Children’s Healthcare of Atlanta.

The analysis included 602 patients ages 0 to 21 years who were offered and eligible for clinical trial enrollment. Among these patients, 15.9% were AYA (≥15 years old), 27.7% identified as non-Hispanic Black, and 25.8% were classified as having high acuity of illness at diagnosis (defined as requiring an intensive care unit visit within 30 days before or 72 hours after cancer diagnosis).

Within this group, 72.6% enrolled in a clinical trial. The investigators found that AYA age, public insurance coverage, non-Hispanic Black race/ethnicity, and high acuity of illness were all negatively associated with clinical trial enrollment. A diagnosis of leukemia was positively associated with enrollment. After adjusting for sex, race/ethnicity, primary language, health insurance type, and blood cancer subtype, AYAs and people of non-Hispanic Black race/ethnicity were still 55% and 49% less likely, respectively, to enroll in a clinic trial relative to their counterparts. Patients with leukemia were more than 5 times as likely as those with lymphoma to enroll in a clinical trial.

The investigators noted that ongoing research in this study is aimed at understanding the reasons for clinical trial nonparticipation based on age and race/ethnicity.