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Wasifuddin M, Ilerhunmwuwa NP, Becerra H, Hakobyan N, Shrestha N, Uche IN, Lin H, Abowali H, Zheng J, Yadav R, Pokhrel A, Enayati L, Hare M, Hehr R, Kozii K, Gibadullin B, Avezbakiyev B, Wang JC. Racial disparities in the incidence and survival outcomes in diffuse large B-cell lymphoma in adolescents and young adults. Eur J Haematol 2024. [PMID: 38890006 DOI: 10.1111/ejh.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
Diffuse large B-cell Lymphoma (DLBCL) is an aggressive subtype of non-Hodgkin lymphoma (NHL). The disease generally occurs in older patients. Although at a lower prevalence, the disease also occurs in the adolescent and young adult group (AYA). There is paucity of data in the literature on racial and ethnic disparities in the incidence and survival outcomes of DLBCL in the AYA group. The objective of our study is to demonstrate the disparities in these outcomes. Utilizing SEER, we obtained data on patient demographics, incidence, and survival from 2000 to 2020. We observed statistically significant reduced incidence of DLBCL in all racial groups, except the non-Hispanic Asian and Pacific Islander group (NHAPI). The non-Hispanic Black group (NHB) had one of the lowest survival despite showing the largest decrease in incidence in DLBCL. The differences in the survival could be secondary to socioeconomic factors, however other reasons need to be explored. The increased incidence among the NHAPI group mirrors that of large population-based studies in East Asian countries, however, underlying reasons have not been elucidated.
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Affiliation(s)
- Mustafa Wasifuddin
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | | | - Henry Becerra
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Narek Hakobyan
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Neharika Shrestha
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Ifeanyi Nnamdi Uche
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Htet Lin
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Hesham Abowali
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Jin Zheng
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Ruchi Yadav
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Akriti Pokhrel
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Ladan Enayati
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Mitchell Hare
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Rohan Hehr
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Khrystyna Kozii
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Bulat Gibadullin
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Boris Avezbakiyev
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Jen-Chin Wang
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
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Hong D, Yin M, Li J, Deng Z, Ren Z, Zhou Y, Huang S, Yan X, Zhong W, Liu F, Yang C. Cardiovascular mortality among patients with diffuse large B-cell lymphoma: a population-based study. Leuk Lymphoma 2024:1-11. [PMID: 38861618 DOI: 10.1080/10428194.2024.2364830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
We aim to investigate cardiovascular mortality risk among diffuse large B-cell lymphoma (DLBCL) patients and explore cardiovascular mortality trends in the past decades in United States. We extracted data from the Surveillance, Epidemiology, and End Results database for adult patients diagnosed with DLBCL between 1975 and 2019. Standardized mortality ratio, joinpoint regression analysis, and competing risk model were analyzed. Overall, 49,918 patients were enrolled, of whom 4167 (8.3%) cardiovascular deaths were observed, which was 1.22 times the number expected (95%CI, 1.19-1.26). During 1985-2019, the incidence-based cardiovascular mortality rate increased by 0.98% per year (95%CI, 0.58-1.39%), with statistically significant increases in age groups younger than 75 years. The cumulative mortality from cardiovascular disease increased by age but never exceeded that from DLBCL. Older age, male sex, earlier year of diagnosis, lower tumor stage at diagnosis, chemotherapy, radiotherapy, and surgery were all poor prognostic factors for cardiovascular mortality.
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Affiliation(s)
- Danhua Hong
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Mengzhuo Yin
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Jie Li
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zhiyong Deng
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zhilei Ren
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yun Zhou
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Shuijin Huang
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xuejun Yan
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
- School of Medicine, Institute of Clinical Medicine, Center for Medical Research on Innovation and Translation, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Weijie Zhong
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Feng Liu
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Chongzhe Yang
- Department of Geriatrics, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
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Pennings ERA, Durmaz M, Visser O, Posthuma EFM, Issa DE, Chamuleau MED, Lugtenburg PJ, Kersten MJ, Dinmohamed AG. Treatment and outcomes for patients with relapsed or refractory diffuse large B-cell lymphoma: a contemporary, nationwide, population-based study in the Netherlands. Blood Cancer J 2024; 14:3. [PMID: 38177115 PMCID: PMC10766619 DOI: 10.1038/s41408-023-00970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Elise R A Pennings
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Müjde Durmaz
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eduardus F M Posthuma
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Djamila E Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Martine E D Chamuleau
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieternella J Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
- Department of Hematology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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4
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Bodla ZH, Hashmi M, Niaz F, Farooq U, Khalid F, Tariq MJ, Khalil MJ, Brown VS, Bray CL. Independent predictors of mortality and 5-year trends in mortality and resource utilization in hospitalized patients with diffuse large B cell lymphoma. Proc AMIA Symp 2023; 37:16-24. [PMID: 38174025 PMCID: PMC10761168 DOI: 10.1080/08998280.2023.2267921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/24/2023] [Indexed: 01/05/2024] Open
Abstract
Background This retrospective study analyzed factors influencing all-cause inpatient mortality in 80,930 adult patients (2016-2020) with diffuse large B cell lymphoma using the National Inpatient Sample database. Methods Utilizing ICD-10 codes, patients were identified, and statistical analysis was conducted using STATA. Fisher's exact and Student's t tests compared proportions and variables, multivariate logistic regression examined mortality predictors, and a 5-year longitudinal analysis identified mortality and resource utilization trends. Results The inpatient mortality rate was found to be 6.56% with a mean age of 67.99 years. Several hospital- and patient-level factors including specific comorbidities such as congestive heart failure, atrial fibrillation, acute kidney injury, chronic obstructive pulmonary disease, liver failure, pancytopenia, tumor lysis syndrome, and severe protein-calorie malnutrition were independently associated with inpatient mortality. Hospitalization costs showed an increasing trend, impacting the overall population and survivors. Conclusion These insights may refine risk assessment, treatment selection, and interventions.
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Affiliation(s)
- Zubair Hassan Bodla
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, Florida, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, USA
| | - Mariam Hashmi
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, USA
| | - Fatima Niaz
- King Edward Medical University, Lahore, Punjab, Pakistan
- Mayo Hospital, Lahore, Punjab, Pakistan
| | - Umer Farooq
- Rochester Regional Health, Rochester, New York, USA
| | - Farhan Khalid
- Monmouth Medical Center, Long Branch, New Jersey, USA
| | | | | | - Victoria S. Brown
- Florida Cancer Specialists and Research Institute, Gainesville, Florida, USA
| | - Christopher L. Bray
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, Florida, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, USA
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Borchmann P, Heger JM, Mahlich J, Papadimitrious MS, Riou S, Werner B. Survival outcomes of patients newly diagnosed with diffuse large B-cell lymphoma: real-world evidence from a German claims database. J Cancer Res Clin Oncol 2023; 149:7091-7101. [PMID: 36871091 DOI: 10.1007/s00432-023-04660-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma with increasing incidence. Although the burden of disease is high, only limited current real-world data on survival analysis, especially survival time, of German patients with DLBCL are available. This retrospective claims-based analysis was conducted to describe real-world survival evidence and treatment patterns of patients with DLBCL in Germany. METHODS Using a large claims database of the German statutory health insurance with 6.7 million enrollees, we identified patients between 2010 and 2019 who were newly diagnosed with DLBCL (index date) and had no other cancer co-morbidity. Overall survival (OS) from index date and from the end of each treatment line was plotted by means of the Kaplan-Meier estimator, both for the overall cohort and stratified by treatment regimen. Treatment lines were identified based on a predefined set of medications categorized by established DLBCL treatment recommendations. RESULTS 2495 incident DLBCL patients were eligible for the study. After index date, 1991 patients started a first-line, 868 a second-line, and 354 a third-line therapy. In first line, 79.5% of patients received a Rituximab-based therapy. 5.0% of the of the 2495 patients received a stem cell transplantation. Overall, median OS after index was 96.0 months. CONCLUSION DLBCL-associated mortality is still high, especially in relapsed patients and in the elderly. Therefore, there is a high medical need for new effective treatments that can improve survival outcomes in DLBCL patients.
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Affiliation(s)
- Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Jan-Michel Heger
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Jörg Mahlich
- Miltenyi Biomedicine, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany.
- DICE-Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | | | - Sybille Riou
- Miltenyi Biomedicine, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany
| | - Barbara Werner
- Team Gesundheit Gesellschaft für Gesundheitsmanagement mbH, Rellinghauser Str. 93, 45128, Essen, Germany
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Dada R. Redefining Precision Management of r/r Large B-Cell Lymphoma: Novel Antibodies Take on CART and BMT in the Quest for Future Treatment Strategies. Cells 2023; 12:1858. [PMID: 37508523 PMCID: PMC10378108 DOI: 10.3390/cells12141858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
The treatment paradigms for patients with relapsed large B-cell lymphoma are expanding. Chimeric antigen receptor technology (CAR-T) has revolutionized the management of these patients. Novel bispecific antibodies and antibody-drug conjugates, used as chemotherapy-free single agents or in combination with other novel therapeutics, have been quickly introduced into the real-world setting. With such a paradigm shift, patients have an improved chance of better outcomes with unpredictable complete remission rates. Additionally, the excellent tolerance of new antibodies targeting B-cell lymphomas is another motivation to broaden its use in relapsed and refractory patients. With the increasing number of approved therapy approaches, future research needs to focus on optimizing the sequence and developing new combination strategies for these antibodies, both among themselves and with other agents. Clinical, pathological, and genetic risk profiling can assist in identifying which patients are most likely to benefit from these costly therapeutic options. However, new combinations may lead to new side effects, which we must learn to deal with. This review provides a comprehensive overview of the current state of research on several innovative antibodies for the precision management of large B-cell lymphoma. It explores various treatment strategies, such as CAR-T vs. ASCT, naked antibodies, antibody-drug conjugates, bispecific antibodies, and bispecific T-cell engagers, as well as discussing the challenges and future perspectives of novel treatment strategies. We also delve into resistance mechanisms and factors that may affect decision making. Moreover, each section provides a detailed analysis of the available literature and ongoing clinical trials.
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Affiliation(s)
- Reyad Dada
- King Faisal Specialist Hospital and Research Centre, Jeddah 21499, Saudi Arabia; ; Tel.: +966-2-6677777 (ext. 64065); Fax: +966-2-6677777 (ext. 64030)
- College of Medicine, Al-Faisal University, Riyadh 11533, Saudi Arabia
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Melnik BC, Stadler R, Weiskirchen R, Leitzmann C, Schmitz G. Potential Pathogenic Impact of Cow’s Milk Consumption and Bovine Milk-Derived Exosomal MicroRNAs in Diffuse Large B-Cell Lymphoma. Int J Mol Sci 2023; 24:ijms24076102. [PMID: 37047075 PMCID: PMC10094152 DOI: 10.3390/ijms24076102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Epidemiological evidence supports an association between cow’s milk consumption and the risk of diffuse large B-cell lymphoma (DLBCL), the most common non-Hodgkin lymphoma worldwide. This narrative review intends to elucidate the potential impact of milk-related agents, predominantly milk-derived exosomes (MDEs) and their microRNAs (miRs) in lymphomagenesis. Upregulation of PI3K-AKT-mTORC1 signaling is a common feature of DLBCL. Increased expression of B cell lymphoma 6 (BCL6) and suppression of B lymphocyte-induced maturation protein 1 (BLIMP1)/PR domain-containing protein 1 (PRDM1) are crucial pathological deviations in DLBCL. Translational evidence indicates that during the breastfeeding period, human MDE miRs support B cell proliferation via epigenetic upregulation of BCL6 (via miR-148a-3p-mediated suppression of DNA methyltransferase 1 (DNMT1) and miR-155-5p/miR-29b-5p-mediated suppression of activation-induced cytidine deaminase (AICDA) and suppression of BLIMP1 (via MDE let-7-5p/miR-125b-5p-targeting of PRDM1). After weaning with the physiological termination of MDE miR signaling, the infant’s BCL6 expression and B cell proliferation declines, whereas BLIMP1-mediated B cell maturation for adequate own antibody production rises. Because human and bovine MDE miRs share identical nucleotide sequences, the consumption of pasteurized cow’s milk in adults with the continued transfer of bioactive bovine MDE miRs may de-differentiate B cells back to the neonatal “proliferation-dominated” B cell phenotype maintaining an increased BLC6/BLIMP1 ratio. Persistent milk-induced epigenetic dysregulation of BCL6 and BLIMP1 expression may thus represent a novel driving mechanism in B cell lymphomagenesis. Bovine MDEs and their miR cargo have to be considered potential pathogens that should be removed from the human food chain.
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Yousefi Z, Sharifzadeh S, Zare F, Eskandari N. Fc receptor-like 1 (FCRL1) is a novel biomarker for prognosis and a possible therapeutic target in diffuse large B-cell lymphoma. Mol Biol Rep 2023; 50:1133-1145. [PMID: 36409389 DOI: 10.1007/s11033-022-08104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma, which can involve various types of mature B-cells. Considering that the incidence of DLBCL has increased, additional research is required to identify novel and effective prognostic and therapeutic molecules. Fc receptor-like 1 (FCRL1) acts as an activation co-receptor of human B-cells. Aberrant expression of this molecule has been reported in a number of B-cell-related disorders. Moreover, the clinical significance and prognosis value of FCRL1 in DLBCL are not completely identified. METHODS In this study, the expression levels of FCRL1 were determined in thirty patients with DLBCL and 15 healthy controls (HCs). In addition, the correlation between FCRL1 expressions with clinicopathological variables of DLBCL patients were examined. Then, the potential roles of FCRL1 in proliferation, apoptosis, and cell cycle distribution of B-cells from DLBCL patients were determined using flow cytometry analysis, after knockdown of this marker using retroviral short hairpin RNA interference. Quantitative real time-PCR, western blotting, and enzyme-linked immunosorbent assay were also used to identify the possible effects of FCRL1 knockdown on the expression levels of BCL-2, BID, BAX, intracellular signaling pathway PI3K/p-Akt, and p65 nuclear factor-kappa B (NF-κB) in the B-cells of DLBCL. RESULTS Statistical analysis revealed higher levels of FCRL1 expression in the B-cells of DLBCL patients compared to HCs at both protein and mRNA levels. A positive correlation was observed between the FCRL1 expression and some clinicopathological parameters of DLBCL patients. In addition, FCRL1 knockdown significantly decreased cell proliferation and stimulated apoptosis as well as G1 cell cycle arrest in the B-cells of DLBCL patients. The levels of p65 NF-κB and PI3K/p-Akt expressions were markedly reduced after knockdown of FCRL1 expression. CONCLUSIONS These results suggested that FCRL1 could be a potential novel biomarker for prognosis and/or a possible effective therapeutic target for treatment of patients with DLBCL.
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Affiliation(s)
- Zahra Yousefi
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sedigheh Sharifzadeh
- Division of Medical Biotechnology, Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Diagnostic Laboratory Sciences and Technology Research Center, Faculty of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farahnaz Zare
- Division of Medical Biotechnology, Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Diagnostic Laboratory Sciences and Technology Research Center, Faculty of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Eskandari
- Department of Immunology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Chen Y, Xu J, Meng J, Ding M, Guo Y, Fu D, Liu A. Establishment and evaluation of a nomogram for predicting the survival outcomes of patients with diffuse large B-cell lymphoma based on International Prognostic Index scores and clinical indicators. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:71. [PMID: 36819580 PMCID: PMC9929781 DOI: 10.21037/atm-22-6023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/07/2023] [Indexed: 01/31/2023]
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma, treatment outcomes of patients vary greatly. The current International Prognostic Index (IPI) is not enough to distinguish patients with poor prognosis, and genetic testing is very expensive, so a inexpensive risk prediction tool should be developed for clinicians to quickly identify the poor prognosis of DLBCL patients. Methods DLBCL patients (n=420; 18-80 years old) who received a combination of cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) with or without rituximab (R-CHOP) at our hospital between 2008 and 2017 were included in the study. Potential predictors of survival were determined by univariate and multivariate Cox regression analyses, and significant variables were used to construct predictive nomograms. The new prediction models were assessed using concordance indexes (C-indexes), calibration curves, and their clinical utility was assessed by decision curve analyses (DCAs). Results The 5-year overall survival (OS) rate was 70.62% and the 5-year progression-free survival (PFS) rate was 59.02%. The multivariate Cox analysis indicated that IPI, Ki-67, the lymphocyte/monocyte ratio, and first-line treatment with rituximab were significantly associated with survival. The C-index results indicated that a predictive model that included these variables had better discriminability for OS (0.73 vs. 0.67) and PFS (0.68 vs. 0.63) than the IPI-based model. The calibration plots showed good agreement with observations and nomogram predictions. The DCAs demonstrated the clinical value of the nomograms. Conclusions Our study identified prognostic factors in patients who were newly diagnosed with DLBCL to construct an individualized risk prediction model, combined IPI with common clinical indicators. Our model might be a valuable tool that could be used to predict the prognosis of DLBCL patients who receive standard first-line treatment regimens. It enables clinicians to quickly identify some patients with possible poor prognosis and choose more active treatment for patients, such as chimeric antigen receptor T-cell (CART) Immunotherapy and other new drugs therapy, so as to prolong the PFS and OS of patients.
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Affiliation(s)
- Yao Chen
- Hemolymph Department, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiaqin Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Jiao Meng
- Hemolymph Department, Harbin Medical University Cancer Hospital, Harbin, China
| | - Mingshuang Ding
- Hemolymph Department, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yiwei Guo
- Hemolymph Department, Harbin Medical University Cancer Hospital, Harbin, China
| | - Dongwei Fu
- Oncology Department, Heilongjiang Provincial Hospital of General Bureau of Agriculture, Harbin, China
| | - Aichun Liu
- Hemolymph Department, Harbin Medical University Cancer Hospital, Harbin, China
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10
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Shi Y, Chen H, Qin Y, Yang J, Liu P, He X, Zhou S, Zhou L, Zhang C, Song Y, Liu Y, Gui L, Wang S, Jin J, Fang H, Qi S, Li N, Tang Y, Wang X, Yang S. Clinical characteristics and treatment outcomes of Chinese diffuse large B-cell lymphoma patients in the era of rituximab (2005-2018). CANCER PATHOGENESIS AND THERAPY 2023; 1:3-11. [PMID: 38328609 PMCID: PMC10846337 DOI: 10.1016/j.cpt.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/15/2022] [Accepted: 09/29/2022] [Indexed: 02/09/2024]
Abstract
Background Rituximab combined with cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP) regimen has improved the survival of diffuse large B-cell lymphoma (DLBCL) patients worldwide, compared with CHOP alone. Several limitations were seen in previous studies of Chinese DLBCL patients treated with R-CHOP or R-CHOP-like regimens. This study aimed to investigate the clinical characteristics and treatment outcomes of Chinese DLBCL patients treated with the standard first-line treatment. Methods Clinical data were collected from DLBCL patients who received frontline R-CHOP or R-CHOP-like regimens at the Cancer Hospital Chinese Academy of Medical Sciences & Peking Union Medical College (CHCAMS) between January 1, 2005, and December 31, 2018. The treatment outcomes were compared with those of patients diagnosed with DLBCL between 2004 and 2017 and who received immunochemotherapy from the United States Surveillance, Epidemiology, and End Results (SEER) database. Survival rates were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis of progression-free survival (PFS) and overall survival (OS) was performed using Cox proportional hazard regression. Results Overall, 1084 patients from the CHCAMS and 4013 patients from the SEER database were included in the study. As of April 30, 2022, the median follow-up period for the CHCAMS group was 87.3 (range: 0.5-195.4) months. For the CHCAMS group, the 5-year PFS and OS rates were 61.7% (95% confidence interval [CI]: 58.8-64.7%) and 70.6% (95% CI: 67.8-73.4%), respectively. For the SEER group, the 5-year OS rate was 66.5% (95% CI: 65.0-68.0%), which was inferior to that of the CHCAMS group (P < 0.001). After adjusting for clinical factors and treatment, no significant difference was observed in the OS between the CHCAMS and SEER groups (P = 0.867). In the CHCAMS group, multivariate analysis showed that an Eastern Cooperative Oncology Group performance status score ≥2, presence of B symptoms, Ann Arbor stage III-IV, elevated serum β2-microglobulin levels, and bulky mass were independent adverse prognostic factors affecting PFS and OS (P < 0.05). Additionally, patients aged over 60 years, elevated lactate dehydrogenase levels, and more than two extranodal sites were independent adverse prognostic factors for OS (P < 0.05). Local radiotherapy was significantly associated with better PFS (P < 0.001) and OS (P = 0.001). Conclusion After adjusting for clinical and treatment-related factors, no significant difference was observed in the 5-year OS rate between Chinese DLBCL patients treated with standard first-line treatment and those from the SEER database.
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Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Yan Qin
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Jianliang Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Peng Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Xiaohui He
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Shengyu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Liqiang Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Changgong Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Yongwen Song
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Yueping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Shulian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Shunan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
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Clinical Characteristics, Outcomes, and Risk Factors for Patients with Diffuse Large B-Cell Lymphoma and Development of Nomogram to Identify High-Risk Patients. JOURNAL OF ONCOLOGY 2022; 2022:8395246. [DOI: 10.1155/2022/8395246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/08/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
Objectives. To analyse the clinical features, outcomes, and risk factors of patients with diffuse large B-cell lymphoma (DLBCL) in China, with the aim to establish a new prognostic model based on risk factors. Methods. Clinical features and outcomes of 564 patients newly diagnosed with DLBCL from Jan 2009 to May 2017 were analyzed retrospectively. Variables were screened by LASSO regression and nomogram was constructed. Results. The 5-year overall survival (OS) of the cohort was 75%. The 5-year OS of patients differentiated by International Prognostic Index (IPI) score was 90% (score 0–2), 73% (score 3), and 51% (score 4-5), respectively. Age > 60, Eastern Cooperative Oncology Group (ECOG) > 1, Ann Arbor stage III-IV, bone marrow involvement, low level of albumin (ALB), and lymphatic/monocyte ratio (LMR) were independent predictors of OS. The predictive model was developed based on factors including age, bone marrow involvement, LMR, ALB, and ECOG scores. The predictive ability of the model (AUC, 0.77) was better than that of IPI (AUC, 0.74) and NCCN-IPI (AUC, 0.69). The 5-year OS of patients in the low-, intermediate-, and high-risk groups identified by the new predictive model was 89%, 70%, and 33%, respectively. Conclusions. The new prediction model had better predictive performance and could better identify high-risk patients.
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12
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Sylvain C. A drug profile on selinexor for the treatment of refractory diffuse large B-cell lymphoma. Expert Rev Hematol 2022; 15:195-201. [PMID: 35318887 DOI: 10.1080/17474086.2022.2057295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The efficacy of selinexor, the first commercially available exportin inhibitor, has been evaluated in patients with diffuse large B-cell lymphoma (DLBCL) who have received at least 2 lines of therapy. Its role in treatment of DLBCL requires a review of current evidence. AREAS COVERED This review describes the pharmacology of selinexor and the clinical trials of the medication for the treatment of patients with DLBCL. To clarify the role of selinexor in the treatment of DLBCL, a PubMed search was performed for articles on currently available treatments for relapsed/refractory (R/R) DLBCL. EXPERT OPINION Selinexor, which is administered orally, benefits from an advantageous pharmacokinetic profile with toxicity limited to hematological and digestive side effects. It has little or no interaction with other medications and no dose adjustment is required for patients with renal or hepatic impairment. Selinexor has been assessed for treatment of R/R DLBCL in one phase I and one phase II trial. Those studies found a 28% overall response rate, including 12% complete remission, with a median duration of response of 9.3 months. If selinexor's effectiveness as monotherapy is limited, it remains an option when there are no other therapeutic possibilities and can then give long-lasting responses.
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Affiliation(s)
- Choquet Sylvain
- Service d'hématologie Clinique, Hôpital de la Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
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13
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Durmaz M, Visser O, Posthuma EFM, Brouwer RE, Issa DE, de Jong D, Lam KH, Blijlevens NMA, Zijlstra JM, Chamuleau MED, Lugtenburg PJ, Kersten MJ, Dinmohamed AG. Time trends in primary therapy and relative survival of diffuse large B-cell lymphoma by stage: a nationwide, population-based study in the Netherlands, 1989-2018. Blood Cancer J 2022; 12:38. [PMID: 35264598 PMCID: PMC8907354 DOI: 10.1038/s41408-022-00637-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
It is unclear whether survival in diffuse large B-cell lymphoma (DLBCL) continues to increase in an era where rituximab-containing chemotherapy reigns for almost two decades. Therefore, we evaluated trends in primary therapy and relative survival (RS) among Dutch DLBCL patients diagnosed between 1989 and 2018. Analyses were performed separately according to the stage I (N = 6952) and stage II–IV disease (N = 20,676), stratified by calendar period and age (18–64, 65–74, and ≥75 years). The use of chemotherapy ± radiotherapy increased over time across all age and stage groups. As of the mid-2000s, >95% of chemotherapy-treated patients received chemoimmunotherapy, irrespective of age and stage. Overall, RS increased significantly over time across all age groups, especially after 2003 when rituximab-containing chemotherapy had become the standard of care. However, RS increased less pronounced between 2003–2010 and 2011–2018 than between 1989–2002 and 2003–2010. These findings were congruent across all studied stage groups. Five-year RS across the three age groups during 2011–2018 was 96%, 84%, and 67% for stage I DLBCL and 75%, 60%, and 46% for stage II–IV DLBCL. Collectively, survival in DLBCL increased modestly beyond the initial introduction of rituximab, with apparent survival differences across age and stage that warrant novel treatment approaches.
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Affiliation(s)
- Müjde Durmaz
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rolf E Brouwer
- Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Djamila E Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Daphne de Jong
- Amsterdam UMC, Department of Pathology, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - King H Lam
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Josée M Zijlstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Department of Hematology, Amsterdam, The Netherlands
| | - Martine E D Chamuleau
- Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Department of Hematology, Amsterdam, The Netherlands
| | - Pieternella J Lugtenburg
- Department of Hematology, Erasmus MC, Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie José Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Department of Hematology, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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14
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Jhatial MA, Khan M, Rab SU, Shaikh N, Loohana C, Imam Bokhari SW. Outcomes of Diffuse Large B-Cell Non-Hodgkin's Lymphoma After Gemcitabine-Based Second Salvage Chemotherapy: A Single-Center Study. Cureus 2021; 13:e19699. [PMID: 34934569 PMCID: PMC8684307 DOI: 10.7759/cureus.19699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma with a five-year survival of 60%-70% with chemoimmunotherapy consisting of the R-CHOP combination (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone), with a relapse/refractory rate of 20-50%. Salvage therapy with HDT-ASCT is the treatment of choice for patients with relapsed/refractory disease with a success rate of 50%-60%. Patients who do not respond to the first salvage regimen or who relapsed after the first salvage regimen, with or without high-dose chemotherapy (HDT)-autologous stem cell transplantation (ASCT), have poor overall responses and survival and should be offered novel therapies. The objective of our study was to evaluate responses to second salvage, gemcitabine-based therapy with or without HDT-ASCT in a resource-limited setting. Materials and methods This was a retrospective study, including 55 patients aged >18 years, diagnosed with DLBCL and having received gemcitabine-based second salvage chemotherapy. Results The median age was 34 years, only one patient achieved progression-free survival (PFS) of >12 months with ORR of 27% to two cycles of gemcitabine-based combination, two years PFS and OS of 9.6% and 34%, respectively, and a median PFS and OS of four months and 13 months, respectively. Conclusion DLBCL patients, refractory to first-line and first salvage chemotherapy, should be considered for novel therapies or opt for palliative care rather than second salvage chemotherapy and HDT-ASCT, which results in poor overall response and significant toxicities.
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Affiliation(s)
- Mussadique Ali Jhatial
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Manzoor Khan
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Saif Ur Rab
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Naila Shaikh
- Nuclear Medicine, Institution of Nuclear Medicine and Oncology, Lahore, PAK
| | - Chandumal Loohana
- Medical Oncology, Sindh Institute of Urology and Transplantation, Karachi, PAK
| | - Syed W Imam Bokhari
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Jayakrishnan T, Aulakh S, Baksh M, Nguyen K, Ailawadhi M, Samreen A, Parrondo R, Sher T, Roy V, Manochakian R, Paulus A, Chanan-Khan A, Ailawadhi S. Landmark Cancer Clinical Trials and Real-World Patient Populations: Examining Race and Age Reporting. Cancers (Basel) 2021; 13:cancers13225770. [PMID: 34830924 PMCID: PMC8616211 DOI: 10.3390/cancers13225770] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/25/2021] [Accepted: 11/12/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Food and Drug Administration (FDA) drug approvals from July 2007 to June 2019 were reviewed to identify oncology approvals, and trials with age details were reviewed for the study. We hypothesized that the clinical trials that do not report race are likely to suffer from a higher degree of age disparity. The study demonstrated that a significant number of clinical trials leading to cancer drug approvals suffer from racial and age disparity when compared to real-world populations and that the two factors may be interrelated. Age discrepancy between the clinical trial population and the real-world population was higher for studies that did not report race (mean difference −8.8 years (95% CI −12.6 to −5.0 years)) vs. studies that did report it. We recommend continued efforts to recruit diverse populations in clinical trials and make concerted efforts to implement national strategies in order to realize healthcare equity. In the meantime, detailed reporting of patient demographic characteristics in publications should be considered standard. Abstract Background: Concern exists that the clinical trial populations differ from respective cancer populations in terms of their age distribution affecting the generalizability of the results, especially in underrepresented minorities. We hypothesized that the clinical trials that do not report race are likely to suffer from a higher degree of age disparity. Methods: Food and Drug Administration (FDA) drug approvals from July 2007 to June 2019 were reviewed to identify oncology approvals, and trials with age details were selected. The outcomes studied were the weighted mean difference in age between the clinical trial population and real-world population for various cancers, the prevalence of race reporting and association of age and race reporting with each other. Results: Of the 261 trials, race was reported in 223 (85.4%) of the trials, while 38 trials (14.6%) had no mention of race. Race reporting improved minimally over time: 29 (85.3%) in 2007–2010 vs. 49 (80.3%) in 2011–2014 vs. 145 (85.4%) during the period 2015–2019 (p-value = 0.41). Age discrepancy between the clinical trial population and the real-world population was higher for studies that did not report race (mean difference −8.8 years (95% CI −12.6 to −5.0 years)) vs. studies that did report it (mean difference −5.1 years, (95% CI −6.4 to −3.7 years), p-value = 0.04). Conclusion: The study demonstrates that a significant number of clinical trials leading to cancer drug approvals suffer from racial and age disparity when compared to real-world populations, and that the two factors may be interrelated. We recommend continued efforts to recruit diverse populations.
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Affiliation(s)
- Thejus Jayakrishnan
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, OH 44106, USA;
| | - Sonikpreet Aulakh
- Departments of Internal Medicine and Neurosciences, West Virginia University, Morgantown, WV 26506, USA;
| | - Mizba Baksh
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Kianna Nguyen
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA;
| | - Meghna Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Ayesha Samreen
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Ricardo Parrondo
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Taimur Sher
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Vivek Roy
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Rami Manochakian
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
| | - Aneel Paulus
- Division of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Asher Chanan-Khan
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
- Division of Hematology-Oncology, St. Vincent’s Cancer Center, Jacksonville, FL 32224, USA
| | - Sikander Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL 100151, USA; (M.B.); (M.A.); (A.S.); (R.P.); (T.S.); (V.R.); (R.M.); (A.C.-K.)
- Division of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224, USA;
- Correspondence: ; Tel.: +1-9049532000; Fax: +1-9049532315
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16
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Epperla N, Vaughn JL, Othus M, Hallack A, Costa LJ. Recent survival trends in diffuse large B-cell lymphoma--Have we made any progress beyond rituximab? Cancer Med 2020; 9:5519-5525. [PMID: 32558356 PMCID: PMC7402846 DOI: 10.1002/cam4.3237] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Population‐based studies previously showed an improvement in overall survival (OS) for patients with diffuse large B‐cell lymphoma (DLBCL) who received chemoimmunotherapy with rituximab. However, there is limited data (especially at the population level) that show a similar trend in OS improvement, in the most recent time period. We hypothesized that survival for DLBCL patients diagnosed in the United States has continued to improve in recent years and intended to measure outcome improvements. Methods Using the SEER‐18 registries, we compared the incidence and relative survival rates (RSRs) of DLBCL patients between 2002‐2007 and 2008‐2013 (availability of novel agents, broader use of autologous hematopoietic cell transplantation and improvement in supportive care). Multivariable Cox regression models were used to assess associations between the year of diagnosis and OS while controlling for age, gender, stage, and ethnicity. Results There were a total of 53 439 patients with DLBCL who were diagnosed between 2002 and 2013. Of these, 25 810 were diagnosed during time period‐1 and 27 629 diagnosed during time period‐2. There was a slight decline in incidence of DLBCL (time period‐1 vs time period‐2), 7.75 (95% CI = 7.66‐7.84) vs 7.43 (95% CI = 7.34‐7.52) cases per 100 000 persons, respectively (P < .0001). Overall, there was a modest improvement in DLBCL RSRs, with 5‐year RSR improving from 61% (time period‐1) to 64% (time period‐2) and the improvement was noted across all subsets of patients. On multivariable analysis, patients diagnosed in time period‐2 had lower mortality relative to time period‐1 (HR = 0.87, 95% CI = 0.85‐0.89). Conclusions Our study shows an improvement in the outcomes of DLBCL patients beyond the introduction of rituximab, although the magnitude of improvement is small. It will be interesting to see the impact of chimeric antigen receptor‐T cell therapy translating to population‐level survival in the next 5 years.
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Affiliation(s)
| | - John L Vaughn
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Megan Othus
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Abrahao Hallack
- Division of Hematology and Bone Marrow Transplantation, Universidade Federal de Juiz de Fora, BR, USA
| | - Luciano J Costa
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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