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Roman Souza G, Nooruddin Z, Lee S, Boyle L, Lucero KT, Ananth S, Franklin K, Mader M, Toro Velez E, Naqvi A, Kaur S. The Impact of Time From Diagnosis to Initiation of Chemotherapy on Survival of Patients With Newly Diagnosed Diffuse Large B-Cell Lymphoma in the Veterans Health Administration. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e67-e77. [PMID: 38151390 DOI: 10.1016/j.clml.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Our retrospective study evaluates the impact of time from diagnosis to treatment (TDT) on outcomes of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) treated within the Veterans Health Administration (VHA). METHODS VHA patients diagnosed with DLBCL between 2011 and 2019 were included, while those with primary central nervous system lymphoma were excluded. The median overall survival and progression-free survival were estimated with the Kaplan-Meier method. Univariate, bivariate, and multivariable analyses were performed using the Cox proportional hazards model. The odds ratio for refractory outcomes was calculated using logistic regression. RESULTS A total of 2448 patients were included. The median time from diagnosis to treatment of the cohort was 19 days. When comparing median progression-free survival, median overall survival, and the 2-year overall survival between the group that started treatment within 1 week and each of the other groups individually, there was a significant difference favoring improved survival in all groups with a TDT longer than 1 week (P < .0001). These patients also had a lower odds ratio for refractory outcomes. On multivariable analysis, TDT remained an independent prognostic factor. CONCLUSION Our study shows that a TDT equal to or less than 1 week is associated with adverse clinical factors, worse outcomes, and response in DLBCL, even after adjusting for multiple known poor prognostic factors. This was the first time that response to first-line therapy was correlated to time to treatment. Our findings support ongoing efforts to improve currently standardized prognostic tools and the incorporation of TDT into clinical trials to avoid selection bias.
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Affiliation(s)
| | - Zohra Nooruddin
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Sophia Lee
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Lauren Boyle
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Kana Tai Lucero
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | | | | | - Michael Mader
- South Texas Veterans Health Care System, San Antonio, TX
| | | | - Amna Naqvi
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Supreet Kaur
- University of Texas Health Science Center San Antonio, San Antonio, TX
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George H, Gunawardana J, Keane C, Hicks RJ, Gandhi MK. A coordinated strategy for a simple, pragmatic approach to the early identification of the ultra-high-risk patient with diffuse large B-cell lymphoma. Intern Med J 2023; 53:1105-1109. [PMID: 37032307 DOI: 10.1111/imj.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most frequent aggressive lymphoma seen in clinical practice. Despite huge strides in understanding its biology, front-line therapy has remained unchanged for decades. Roughly one-third of patients have primary refractory or relapse following the end of conventional first-line therapy. The outcome of patients with primary refractory disease and those with early relapse (defined as relapse less than 1 year from the end of therapy) is markedly inferior to those with later relapse and is exemplified by dismal overall survival. In this article, the authors term patients with features that identify them as being at particularly high-risk for either primary refractory disease or early relapse, as 'ultra-high-risk'. As new treatment options become established (e.g. bispecific T-cell engagers, chimeric antigen receptor 'CAR' T-cells and antibody-drug conjugates), it is likely that there will be a push to incorporate some of these agents into the first-line setting for patients identified as ultra-high-risk. In this review, the authors outline advances in positron emission tomography, widely available laboratory assays and clinical prognosticators, which can detect a high proportion of patients with ultra-high-risk disease. Since these approaches are pragmatic and able to be adopted widely, they could be incorporated into routine clinical practice.
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Affiliation(s)
| | - Jay Gunawardana
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Colm Keane
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Rod J Hicks
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Maher K Gandhi
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Di M, Keeney T, Belanger E, Huntington SF, Olszewski AJ, Panagiotou OA. Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: A population-based study. J Am Geriatr Soc 2023; 71:2239-2249. [PMID: 36882865 PMCID: PMC10483014 DOI: 10.1111/jgs.18302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To characterize the prevalence of functional and cognitive impairments, and associations between impairments and treatment among older patients with diffuse large B cell lymphoma (DLBCL) receiving nursing home (NH) care. METHODS We used the Surveillance, Epidemiology, and End Results-Medicare database to identify beneficiaries diagnosed with DLBCL 2011-2015 who received care in a NH within -120 ~ +30 days of diagnosis. Multivariable logistic regression was used to compare receipt of chemoimmunotherapy (including multi-agent, anthracycline-containing regimens), 30-day mortality, and hospitalization between NH and community-dwelling patients, estimating odds ratios (OR) and 95% confidence interval (CI). We also examined overall survival (OS). Among NH patients, we examined receipt of chemoimmunotherapy based on functional and cognitive impairment. RESULTS Of the eligible 649 NH patients (median age: 82 years), 45% received chemoimmunotherapy; among the recipients, 47% received multi-agent, anthracycline-containing regimens. Compared with community-dwelling patients, those in a NH were less likely to receive chemoimmunotherapy (OR: 0.34, 95%CI: 0.29-0.41), had higher 30-day mortality (OR: 2.00, 95%CI: 1.43-2.78) and hospitalization (OR: 1.51, 95%CI: 1.18-1.93), and poorer OS (hazard ratio: 1.36, 95%CI: 1.11-1.65). NH patients with severe functional (61%) or any cognitive impairment (48%) were less likely to receive chemoimmunotherapy. CONCLUSIONS High rates of functional and cognitive impairment and low rates of chemoimmunotherapy were observed among NH residents diagnosed with DLBCL. Further research is needed to better understand the potential role of novel and alternative treatment strategies and patient preferences for treatment to optimize clinical care and outcomes in this high-risk population.
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Affiliation(s)
- Mengyang Di
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tamra Keeney
- Center for Aging and Serious Illness, Massachusetts General Hospital, Mongan Institute, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Emmanuelle Belanger
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Scott F. Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Orestis A. Panagiotou
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
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Epperla N, Switchenko J, Bachanova V, Gerson JN, Barta SK, Gordon MJ, Danilov AV, Grover NS, Mathews S, Burkart M, Karmali R, Sawalha Y, Hill BT, Ghosh N, Park SI, Bond DA, Hamadani M, Fenske TS, Martin P, Malecek MK, Kahl BS, Flowers CR, Link BK, Kaplan LD, Inwards DJ, Feldman AL, Hsi ED, Maddocks K, Blum KA, Bartlett NL, Cerhan JR, Leonard JP, Habermann TM, Maurer MJ, Cohen JB. Impact of diagnosis to treatment interval in patients with newly diagnosed mantle cell lymphoma. Blood Adv 2023; 7:2287-2296. [PMID: 36516079 PMCID: PMC10225877 DOI: 10.1182/bloodadvances.2022009225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
The prognostic relevance of diagnosis to treatment interval (DTI) in patients with newly diagnosed mantle cell lymphoma (MCL) is unknown. Hence, we sought to evaluate the impact of DTI on outcomes in MCL using 3 large datasets (1) the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource, (2) patients enrolled in the ALL Age Asthma Cohort/CALGB 50403, and (3) a multisitecohort of patients with MCL. Patients were a priori divided into 2 groups, 0 to 14 days (short DTI) and 15 to 60 days (long DTI). The patients in whom observation was deemed appropriate were excluded. One thousand ninety-seven patients newly diagnosed with MCL and available DTI were included in the study. The majority (73%) had long DTI (n=797). Patients with short DTI had worse eastern cooperative oncology group performance status (ECOG PS ≥2), higher lactate dehydrogenase, bone marrow involvement, more frequent B symptoms, higher MCL International Prognostic Index (MIPI ≥6.2), and were less likely to receive intensive induction therapy than long DTI group. The median progression-free survival (2.5 years vs 4.8 years, p<0.0001) and overall survival (7.8 years vs. 11.8 years, p<0.0001) were significantly inferior in the short DTI group than the long DTI cohort and remained significant for progression-free survival and overall survival in multivariable analysis. We show that the DTI is an important prognostic factor in patients newly diagnosed with MCL and is strongly associated with adverse clinical factors and poor outcomes. DTI should be reported in all the patients newly diagnosed with MCL who are enrolling in clinical trials and steps must be taken to ensure selection bias is avoided.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH
| | | | | | - James N. Gerson
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stefan K. Barta
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Max J. Gordon
- Department of Medicine, MD Anderson Cancer Center, Houston, TX
| | | | - Natalie S. Grover
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Stephanie Mathews
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Madelyn Burkart
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yazeed Sawalha
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH
| | | | - Nilanjan Ghosh
- Department of Medicine, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Steven I. Park
- Department of Medicine, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - David A. Bond
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy S. Fenske
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Peter Martin
- Department of Medicine, Weill Cornell Medical College, Manhattan, NY
| | - Mary-Kate Malecek
- Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Brad S. Kahl
- Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | | | - Brian K. Link
- Department of Medicine, University of Iowa, Iowa City, IA
| | | | | | | | - Eric D. Hsi
- Department of Medicine, Wake Forest University, Winston-Salem, NC
| | - Kami Maddocks
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH
| | | | - Nancy L. Bartlett
- Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | | | - John P. Leonard
- Department of Medicine, Weill Cornell Medical College, Manhattan, NY
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Yin J, Xie X, Quan Y, Wang Z, Liu S, Su Q, Che F, Wang L. RNA-seq analysis reveals candidate genes associated with proliferation, invasion, and migration in BCL11A knockdown B-NHL cell lines. Ann Hematol 2023:10.1007/s00277-023-05247-w. [PMID: 37148312 DOI: 10.1007/s00277-023-05247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
B-cell lymphoma/leukemia 11A (BCL11A) is highly expressed in B-cell non-Hodgkin lymphoma (B-NHL), blocks cell differentiation, and inhibits cell apoptosis. However, little is known about BCL11A in the proliferation, invasion, and migration of B-NHL cells. Here, we found increased expression of BCL11A in B-NHL patients and cell lines. Knockdown of BCL11A suppressed the proliferation, invasion, and migration of B-NHL cells in vitro and reduced tumor growth in vivo. RNA sequencing (RNA-seq) and KEGG pathway analysis demonstrated that BCL11A-targeted genes were significantly enriched in the PI3K/AKT signaling pathway, focal adhesion, and extracellular matrix (ECM)-receptor interaction (including COL4A1, COL4A2, FN1, SPP1), and SPP1 was the most significantly downregulated gene. qRT‒PCR, western blotting, and immunohistochemistry revealed that silencing BCL11A reduced the expression level of SPP1 in Raji cells. Our study suggested that high level of BCL11A may promote B-NHL proliferation, invasion, and migration, and the BCL11A-SPP1 regulatory axis may play an important role in Burkitt's lymphoma.
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Affiliation(s)
- Jiawei Yin
- Central Laboratory, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China
- Key Laboratory of Tumor Biology, Linyi, Shandong, People's Republic of China
- Key Laboratory for Translational Oncolgoy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Xiaoli Xie
- Central Laboratory, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China
- Key Laboratory of Tumor Biology, Linyi, Shandong, People's Republic of China
- Key Laboratory for Translational Oncolgoy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Yanchun Quan
- Central Laboratory, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China
- Key Laboratory of Tumor Biology, Linyi, Shandong, People's Republic of China
- Key Laboratory for Translational Oncolgoy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Zhiqiang Wang
- Central Laboratory, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China
- Key Laboratory of Tumor Biology, Linyi, Shandong, People's Republic of China
- Key Laboratory for Translational Oncolgoy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Shu Liu
- Central Laboratory, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China
- Department of Neurology, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China
- Key Laboratory of Neurophysiology, Health Commission of Shandong Province, Linyi, Shandong, People's Republic of China
- Key Laboratory of Neurophysiology, Linyi, Shandong, People's Republic of China
| | - Quanping Su
- Central Laboratory, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China
- Department of Neurology, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China
- Key Laboratory of Neurophysiology, Health Commission of Shandong Province, Linyi, Shandong, People's Republic of China
- Key Laboratory of Neurophysiology, Linyi, Shandong, People's Republic of China
| | - Fengyuan Che
- Central Laboratory, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China.
- Department of Neurology, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China.
- Key Laboratory of Neurophysiology, Health Commission of Shandong Province, Linyi, Shandong, People's Republic of China.
- Key Laboratory of Neurophysiology, Linyi, Shandong, People's Republic of China.
| | - Lijuan Wang
- Central Laboratory, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China.
- Key Laboratory of Tumor Biology, Linyi, Shandong, People's Republic of China.
- Key Laboratory for Translational Oncolgoy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.
- Department of Hematology, Linyi People's Hospital, Shandong University, Linyi, Shandong, People's Republic of China.
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Hatic H, Inselman S, Inselman J, Kommalapati A, Tella SH, Paludo J, Durani U, Go RS, Goyal G. Time to first treatment is an independent prognostic factor for Multiple Myeloma (MM). Leuk Res 2022; 123:106966. [DOI: 10.1016/j.leukres.2022.106966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
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Yagi Y, Kanemasa Y, Sasaki Y, Ohigashi A, Morita Y, Tamura T, Nakamura S, Kageyama A, Omuro Y, Shimoyama T. Synchronous multiple primary tumors in patients with malignant lymphoma: a retrospective study. BMC Cancer 2022; 22:640. [PMID: 35690729 PMCID: PMC9188225 DOI: 10.1186/s12885-022-09734-7] [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] [Received: 11/24/2021] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Synchronous multiple primary malignant tumors (sMPMTs) are sometimes diagnosed in patients with malignant lymphoma. We herein investigated the prognostic impact of sMPMT in lymphoma patients and the optimal treatment strategy. Methods Seventy-five patients with sMPMTs (5.8%) among 1285 patients with lymphoma newly diagnosed between August 2004 and April 2020 were enrolled. Results In patients with indolent lymphoma, those with sMPMTs had a worse prognosis than those without sMPMTs (5-year overall survival [OS]: 73.4% and 87.8%, respectively; P = 0.047). Among those with high and low tumor burden, the cumulative rate of death due to solid tumors was significantly higher in patients with sMPMTs than those without sMPMTs (high tumor burden: 26.7% vs. 1.6%, P < 0.001; low tumor burden: 12.7% vs. 1.0%, P = 0.003). The presence of sMPMTs did not have a significant impact on outcomes in patients with diffuse large B-cell lymphoma (DLBCL) (5-year OS: 65.4% and 66.9%, respectively; P = 0.74; 5-year progression-free survival [PFS]: 65.5% and 59.9%, respectively; P = 0.65). However, the cumulative rate of death from solid tumor in patients with sMPMTs was significantly higher than in patients without sMPMTs (5-year cumulative rate: 7.4% and 2.1%, respectively; P = 0.004). The treatment sequence did not have a significant effect on outcomes or the relative dose intensity of chemotherapy. Conclusions In patients with indolent lymphoma, those with sMPMTs had a significantly worse prognosis than those without sMPMTs, mainly because of high mortality due to solid tumors. The presence of sMPMTs was not a significant prognostic factor in patients with DLBCL. It is important to assess the status and need for early treatment of each type of malignancy in patients with sMPMTs.
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Affiliation(s)
- Yu Yagi
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yusuke Kanemasa
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Yuki Sasaki
- Department of Clinical Research Support, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - An Ohigashi
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yuka Morita
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Taichi Tamura
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Shohei Nakamura
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Akihiko Kageyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yasushi Omuro
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Miyazaki K, Suzuki R, Oguchi M, Taguchi S, Amaki J, Takeshi M, Kubota N, Maruyama D, Terui Y, Sekiguchi N, Takizawa J, Tsukamoto H, Murayama T, Ando T, Matsuoka H, Hasegawa M, Wada H, Sakai R, Kameoka Y, Tsukamoto N, Choi I, Masaki Y, Shimada K, Fukuhara N, Utsumi T, Uoshima N, Kagami Y, Asano N, Ejima Y, Katayama N, Yamaguchi M. Long-term outcomes and central nervous system relapse in extranodal natural killer/T-cell lymphoma. Hematol Oncol 2022; 40:667-677. [PMID: 35142384 DOI: 10.1002/hon.2977] [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: 09/16/2021] [Revised: 01/13/2022] [Accepted: 02/06/2022] [Indexed: 11/10/2022]
Abstract
To elucidate the long-term outcomes of non-anthracycline-containing therapies and central nervous system (CNS) events in patients with extranodal NK/T-cell lymphoma, nasal type (ENKTL), the clinical data of 313 patients with ENKTL diagnosed between 2000 and 2013 in a nationwide retrospective study in Japan were updated and analyzed. At a median follow-up of 8.4 years, the 5-year overall survival (OS) and progression-free survival (PFS) were 71% and 64%, respectively, in 140 localized ENKTL patients who received radiotherapy and dexamethasone, etoposide, ifosfamide, and carboplatin (RT-DeVIC) in clinical practice. Nine (6.4%) patients experienced second malignancies. In 155 localized ENKTL patients treated with RT-DeVIC, 10 (6.5%) experienced CNS relapse (median, 12.8 months after diagnosis). In 5 of them, the events were confined to the CNS. Nine of the 10 patients who experienced CNS relapse died within 1 year after CNS relapse. Multivariate analysis identified gingival (HR, 54.35; 95% CI, 8.60-343.35) and paranasal involvement (HR, 7.42; 95% CI, 1.78-30.89) as independent risk factors for CNS relapse. In 80 advanced ENKTL patients, 18 received dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) chemotherapy as first-line treatment. Patients who received SMILE as their first-line treatment tended to have better OS than those who did not (P = 0.071). Six (7.5%) advanced ENKTL patients experienced isolated CNS relapse (median, 2.6 months after diagnosis) and died within 4 months of relapse. No second malignancies were documented in advanced ENKTL patients. In the entire cohort, the median OS after first relapse or progression was 4.6 months. Twelve patients who survived 5 years after PFS events were disease-free at the last follow-up. Of those, 11 (92%) underwent hematopoietic SCT. Our 8-year follow-up revealed the long-term efficacy and safety of RT-DeVIC and SMILE. The risk of CNS relapse is an important consideration in advanced ENKTL. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | | | | | - Jun Amaki
- Division of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Maeda Takeshi
- Department of Haematology and Oncology, Kurashiki Center Hospital, Kurashiki, Japan
| | - Nobuko Kubota
- Division of Hematology, Saitama Cancer Center, Ina, Japan
| | - Dai Maruyama
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhito Terui
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Hematology, Saitama Medical University, Moroyama, Japan
| | - Nodoka Sekiguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Hiroyuki Tsukamoto
- Division of Hematology, Showa University School of Medicine, Tokyo, Japan
| | - Tohru Murayama
- Department of Hematology, Hyogo Cancer Center, Akashi, Japan
| | - Toshihiko Ando
- Division of Hematology, Respiratory Medicine and Oncology, Saga University, Saga, Japan
| | | | - Masatoshi Hasegawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
| | - Hideho Wada
- Department of Hematology, Kawasaki Medical School, Kurashiki, Japan
| | - Rika Sakai
- Department of Hematology and Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | | | | | - Ilseung Choi
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yasufumi Masaki
- Division of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University School of Medicine, Nagoya, Japan
| | - Noriko Fukuhara
- Department of Hematology & Rheumatology, Tohoku University School of Medicine, Sendai, Japan
| | - Takahiko Utsumi
- Department of Hematology, Shiga General Hospital, Moriyama, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | | | - Naoko Asano
- Department of Molecular Diagnostics, Nagano Prefectural Shinshu Medical Center, Suzaka, Japan
| | - Yasuo Ejima
- Department of Radiology, Dokkyo Medical University, Shimotsuga, Japan
| | - Naoyuki Katayama
- Department of Hematology and Oncology.,Suzuka University of Medical Science, Suzuka, Japan
| | - Motoko Yamaguchi
- Department of Hematology and Oncology.,Department of Hematological Malignancies, Mie University Graduate School of Medicine, Tsu, Japan
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9
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Hounsome L, Eyre TA, Ireland R, Hodson A, Walewska R, Ardeshna K, Chaganti S, McKay P, Davies A, Fox CP, Kalakonda N, Fields PA. Diffuse large B cell lymphoma (DLBCL) in patients older than 65 years: analysis of 3 year Real World data of practice patterns and outcomes in England. Br J Cancer 2022; 126:134-143. [PMID: 34611308 PMCID: PMC8727618 DOI: 10.1038/s41416-021-01525-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/10/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We wished to examine treatment and outcome patterns in older diffuse large B-cell lymphoma (DLBCL) patients, with a focus on the effect of route-to-diagnosis to outcome. METHODS Data were extracted from Public Health England's National Cancer Registration and Analysis Service between 2013 and 2015 included route-to-diagnosis, disease characteristics and survival for 9186 patients ≥65 years. Systemic Anti-Cancer Therapy data identified front-line regimens, cycles and doses. RESULTS Route-to-diagnosis were emergency (34%), NHS urgent cancer pathway (rapid haemato-oncologist review <2 weeks), (29%) and standard GP referral (25%). The most common regimen was R-CHOP (n = 4392). 313 patients received R-miniCHOP (7% of R-CHOP). For all patients, 3-year overall survival (OS) for 65-79 years was 57% and for ≥80 years was 32%. Three-year OS for R-CHOP-treated patients diagnosed via emergency presentation was 54% (adjusted hazard ratio (HR) 1.63, p < 0.01) and 75% (adjusted HR 0.81, p < 0.01) on the NHS urgent cancer pathway (reference HR:1.00: GP referrals). 3-year OS was 54% for both R-miniCHOP and R-CHOP in ≥80 years. CONCLUSIONS Our comprehensive population analysis is the first to show that the NHS urgent cancer pathway is associated with a superior survival after adjusting for multiple confounders. Equivalent survival for R-CHOP and R-mini-CHOP was demonstrated in those ≥80 years.
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Affiliation(s)
- L. Hounsome
- grid.271308.f0000 0004 5909 016XPublic Health England, London, UK
| | - T. A. Eyre
- grid.410556.30000 0001 0440 1440Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R. Ireland
- grid.13097.3c0000 0001 2322 6764Department of Haematology, Kings College London Hospitals, London, UK
| | - A. Hodson
- grid.414810.80000 0004 0399 2412Department of Haematology, Ipswich Hospital, Ipswich, UK
| | - R. Walewska
- Department of Haematology, University Hospitals Dorset, Bournemouth, UK
| | - K. Ardeshna
- grid.52996.310000 0000 8937 2257Department of Haematology, UCLH, London, UK
| | - S. Chaganti
- grid.412563.70000 0004 0376 6589Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - P. McKay
- Department of Haematology, Beatson Cancer Centre, Glasgow, UK
| | - A. Davies
- grid.123047.30000000103590315Department of Medical Oncology, Southampton General Hospital, Southampton, UK
| | - C. P. Fox
- grid.240404.60000 0001 0440 1889Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - N. Kalakonda
- grid.10025.360000 0004 1936 8470Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - P. A. Fields
- grid.425213.3Department of Haematology, Guys and St Thomas’ Hospital, London, UK
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10
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He HX, Gao Y, Bai B, Wang XX, Li JB, Huang C, Mao JY, Ping LQ, Rong QX, He YX, Huang H, Cai QQ, Li ZM, Jiang WQ, Huang HQ. The beneficial effect of Escalated-R-CHOP-21 for the treatment of diffuse large B-cell lymphoma in elderly male patients: A propensity-matched cohort study. Cancer Med 2021; 10:7650-7664. [PMID: 34581023 PMCID: PMC8559475 DOI: 10.1002/cam4.4296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Some studies have indicated that using 500 mg/m2 rituximab combined with CHOP-14 may be beneficial for elderly men but not women with diffuse large B-cell lymphoma (DLBCL). The purpose of this study was to investigate the potential benefit of escalated doses of rituximab with CHOP-21 as the first-line treatment in male patients with DLBCL. METHODS We performed a retrospective cohort study to analyze the survival benefit of rituximab 500 mg/m2 plus the CHOP-21 regimen (Escalated-R-CHOP-21) as the first-line treatment compared with using rituximab 375 mg/m2 plus the CHOP-21 regimen (Standard-R-CHOP-21) in men with DLBCL. We used propensity score matching to maximize the balance of the observed covariables. The primary endpoints of this study were the progression-free survival (PFS) rate and overall survival (OS) rate at 3 years. RESULTS After a median follow-up of 47 months (IQR 31-65), no significant difference in PFS and OS was found for men treated with Escalated-R-CHOP-21 compared with Standard-R-CHOP-21 [3-year PFS: 69.7% versus 71.9%, p = 0.867; 3-year OS: 83.0% versus 82.4%, p = 0.660]. After 1:1 propensity score matching, we found that the patients using Escalated-R-CHOP-21 had statistically significant survival benefits relative to Standard-R-CHOP-21 among the 96 matched elderly male patients for 3-year PFS [75.5% (95% CI 62.8-88.2) versus 58.2% (95% CI 44.3-72.1); p = 0.019] and 3-year OS [86.6% (95% CI 76.4-96.8) versus 65.8% (95% CI 52.1-79.5); p = 0.017]. However, no differences in survival were observed for younger male patients. Furthermore, the dose effect in PFS of Escalated-R-CHOP-21 was more obvious for elderly male patients with no high-risk extranodal sites (p = 0.005 and interaction p = 0.030). CONCLUSION Escalated-R-CHOP-21 could be a safe and effective option for treating elderly male patients with DLBCL. This study provides new insight into optimizing the standard treatment regimen, which may have important therapeutic implications in elderly male patients with DLBCL.
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Affiliation(s)
- Hai-Xia He
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yan Gao
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bing Bai
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Xiao Wang
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ji-Bin Li
- Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Cheng Huang
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jia-Ying Mao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li-Qin Ping
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qi-Xiang Rong
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yan-Xia He
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - He Huang
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qing-Qing Cai
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-Ming Li
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui-Qiang Huang
- State Key Laboratory of Oncology in South China & Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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11
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Brown HJ, Varelas EA, Ganti A, Papagiannopoulos P, Mark M, Kuan EC, Tajudeen BA. Prognostic Indicators of Survival in Sinonasal Diffuse Large B-Cell Lymphoma: A National Cancer Database Analysis. Laryngoscope 2021; 132:1515-1522. [PMID: 34542177 DOI: 10.1002/lary.29864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study offers an update on the epidemiologic and prognostic factors and treatment-specific outcomes in patients diagnosed with sinonasal diffuse large B-cell lymphoma (DLBCL). STUDY DESIGN Retrospective cohort study. METHODS National Cancer Database was queried from 2004 to 2016 for patients with sinonasal DLBCL. Univariate Kaplan-Meier and multivariate Cox-regression analyses were performed to evaluate the association of suspected prognostic factors with overall survival (OS). RESULTS A total of 2,222 patients with sinonasal DLBCL were analyzed. OS was 62% at 5 years and 42% at 10 years. Prognostic factors associated with increased survival included African-American race (HR: 0.48, 95% CI: 0.33-0.70), chemotherapy (HR: 0.30, CI: 0.25-0.35), and radiation (HR: 0.80, CI: 0.69-0.93). Prognostic factors associated with decreased survival included patients with Charlson-Deyo scores of 1 (HR: 1.51, CI: 1.25-1.84), 2 (HR: 2.25, CI: 1.67-3.03), and 3 (HR: 2.36, CI: 1.49-3.74) and patients with Lugano stage III (HR: 1.69, CI: 1.09-2.62) and IV (HR: 1.96, CI: 1.46-2.64) disease. Stage-based split multivariate analysis was performed and revealed chemotherapy was independently associated with increased OS in patients with stage I (HR: 0.24, CI: 0.19-0.30), II (HR: 0.17, CI: 0.11-0.28), and IV (HR: 0.41, CI: 0.26-0.64) disease. Radiotherapy was independently associated with increased OS in patients with stage I disease only (HR: 0.67, CI: 0.55-0.83), while immunotherapy was an independent prognostic factor in patients with stage IV disease only (HR: 0.60, CI: 0.37-0.98). CONCLUSION This study is the largest to date to analyze the association of demographic features and treatment modalities with OS in patients with sinonasal DLBCL. It is the first to investigate the association of immunotherapy with OS in this population. A combination treatment of immunochemotherapy or radioimmunochemotherapy confers increased survival, particularly in patients with advanced disease. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eleni A Varelas
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ashwin Ganti
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Peter Papagiannopoulos
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michelle Mark
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Bobby A Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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12
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Yoshida M, Nakaya Y, Shimizu K, Tatsumi N, Tsutsumi M, Fuseya H, Horiuchi M, Yoshimura T, Hayashi Y, Nakao T, Inoue T, Yamane T. Importance of diagnosis-to-treatment interval in newly diagnosed patients with diffuse large B-cell lymphoma. Sci Rep 2021; 11:2837. [PMID: 33531642 PMCID: PMC7854577 DOI: 10.1038/s41598-021-82615-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/22/2021] [Indexed: 11/09/2022] Open
Abstract
Treatment of patients with malignancy sometimes be delayed due to various reasons. Several studies revealed that an influence of diagnosis-to-treatment interval (DTI) on outcomes differs depending on the type of malignancy. In this study, we evaluated the influence of DTI on clinical outcomes in newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL). A total of 199 patients were identified with a median DTI of 22 days. At 2 years, patients with short DTI (0–22 days) showed significantly poorer OS (62.7% vs 86.4%) and PFS (55.1% vs 75.9%) compared to those with long DTI (over 22 days). Although short DTI was strongly correlated with several known adverse factors, it remained to be an independent prognostic factor by multivariate analysis. In conclusion, our study confirmed the importance of DTI in patients with DLBCL. Researchers should consider DTI as one of the important prognostic factors and plan clinical trials to be able to enroll patients with aggressive disease requiring urgent treatment.
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Affiliation(s)
- Masahiro Yoshida
- Department of Hematology, Osaka City General Hospital, Osaka, Japan.
| | - Yosuke Nakaya
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Katsujun Shimizu
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Naoko Tatsumi
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Minako Tsutsumi
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Hoyuri Fuseya
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Mirei Horiuchi
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Takuro Yoshimura
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Yoshiki Hayashi
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Takafumi Nakao
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Takahisa Yamane
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
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13
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Jayakrishnan TT, Bakalov V, Chahine Z, Lister J, Wegner RE, Sadashiv S. Disparities in the enrollment to systemic therapy and survival for patients with multiple myeloma. Hematol Oncol Stem Cell Ther 2020; 14:218-230. [PMID: 33069693 PMCID: PMC7546959 DOI: 10.1016/j.hemonc.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/02/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background Disparities driven by socioeconomic factors have been shown to impact outcomes for cancer patients. We sought to explore this relationship among patients with multiple myeloma (MM) who were not considered for hematopoietic stem cell transplant in the first-line setting and how it varied over time. Methods We queried the National Cancer Database for patients diagnosed with MM between 2004 and 2016 and included only those who received systemic therapy as the first-line treatment. Enrollment rates for therapy were calculated as receipt of systemic therapy as the incident event of interest (numerator) over time to initiation of therapy (denominator) and used to calculate incident rate ratios that were further analyzed using Poisson regression analysis. A multivariate Cox proportional hazards model was constructed for survival analysis, and differences were reported as hazard ratios (HRs). Results We identified 56,102 patients for enrollment analysis and 50,543 patients for survival analysis. Therapy enrollment in a multivariate model was significantly impacted by race and sex (p < .005). Advanced age, earlier year of diagnosis, lack of insurance or Medicaid, and higher comorbidity were associated with poor survival (HR > 1), whereas female sex, non-Hispanic black race, higher income, and treatment at an academic center were associated with improved survival (HR < 1). Conclusion Disparities in treatment of MM exist and are caused by a complex interplay of multiple factors, with socioeconomic factor playing a significant role. Studies exploring such determinants may help in equitable distribution of resources to overcome such differences.
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Affiliation(s)
| | - Veli Bakalov
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Zena Chahine
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - John Lister
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Santhosh Sadashiv
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
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14
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Maggen C, Dierickx D, Cardonick E, Mhallem Gziri M, Cabrera-Garcia A, Shmakov RG, Avivi I, Masturzo B, Duvekot JJ, Ottevanger PB, O'Laughlin A, Polushkina E, Van Calsteren K, Woei-A-Jin FJSH, Amant F. Maternal and neonatal outcomes in 80 patients diagnosed with non-Hodgkin lymphoma during pregnancy: results from the International Network of Cancer, Infertility and Pregnancy. Br J Haematol 2020; 193:52-62. [PMID: 32945547 DOI: 10.1111/bjh.17103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
This cohort study of the International Network on Cancer, Infertility and Pregnancy (INCIP) reports the maternal and neonatal outcomes of 80 pregnant patients diagnosed with non-Hodgkin lymphoma (NHL) between 1986 and 2019, focussing on 57 (71%) patients with diffuse large B-cell lymphoma (DLBCL). Of all 80 patients, 54 (68%) pregnant patients received chemotherapy; mostly (89%) CHOP-like (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimens. Four early pregnancies were terminated. Among 76 ongoing pregnancies, there was one stillbirth (1·3%). Overall, there was a high incidence of small for gestational age neonates (39%), preterm delivery (52%), obstetric (41%) and neonatal complications (12·5%), and this could not exclusively be explained by the receipt of antenatal chemotherapy. Half of preterm deliveries (46%) were planned in order to tailor oncological treatment. The 3-year progression-free and overall survival for patients with DLBCL treated with rituximab-CHOP was 83·4% and 95·7% for limited stage (n = 29) and 60·6% and 73·3% for advanced stage (n = 15). Of 36 pregnant patients who received rituximab, five (13%) cases with neonatal complications and three (8%) with maternal infections were reported. In conclusion, standard treatment for DLBCL can be offered to pregnant patients in obstetric centres that cater for high-risk patients.
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Affiliation(s)
| | - Daan Dierickx
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Elyce Cardonick
- Department of Obstetrics and Gynaecology, Cooper, University Health Care, Camden, NJ, USA
| | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | - Alvaro Cabrera-Garcia
- Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) "Reference clinic for haemato-oncological diseases during pregnancy CREHER", Estado de México, México
| | - Roman G Shmakov
- National Medical Research Centre for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Irit Avivi
- Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.,Sackler Faculty of Medicine, TA University, Tel Aviv, Israel
| | - Bianca Masturzo
- Department Surgical Sciences, University of Torino, Torino, Italy
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | - Evgeniya Polushkina
- National Medical Research Centre for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Department of Development and regeneration, KU Leuven, Leuven, Belgium
| | - F J Sherida H Woei-A-Jin
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Gynaecological Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.,Department of Gynaecology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
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15
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Zayac AS, Olszewski AJ. Burkitt lymphoma: bridging the gap between advances in molecular biology and therapy. Leuk Lymphoma 2020; 61:1784-1796. [PMID: 32255708 DOI: 10.1080/10428194.2020.1747068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Genomic studies have revealed molecular mechanisms involved in the pathogenesis of Burkitt's lymphoma, including the ID3/TCF3-dependent centroblast gene expression program, tonic PI3K-AKT-mTOR signaling, and deregulation of cell cycle and apoptosis through mutations in cyclin D3, CDKN2A, or TP53. Unfortunately, these advances have not been translated into treatment, which relies on dose-intense cytotoxic chemotherapy. While most patients achieve long-term survival, options for relapsed/refractory disease are lacking, as Burkitt lymphoma is often excluded from clinical trials of novel approaches. The lower-intensity, dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) regimen constitutes a major advance allowing for treatment of older and HIV-positive patients but needs augmentation to better address the central nervous system involvement. Furthermore, DA-EPOCH-R provides a platform for the study of targeted or immunotherapeutic approaches while de-escalating cytotoxic agents and their associated adverse effects. In this review we discuss the epidemiology and molecular genetics of BL, first-line treatment considerations, and potential novel treatment strategies.
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Affiliation(s)
- Adam S Zayac
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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16
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Olszewski AJ, Butera JN, Reagan JL, Castillo JJ. Outcomes of bendamustine- or cyclophosphamide-based first-line chemotherapy in older patients with indolent B-cell lymphoma. Am J Hematol 2020; 95:354-361. [PMID: 31849108 DOI: 10.1002/ajh.25707] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022]
Abstract
Clinical trials comparing bendamustine/rituximab (BR) with cyclophosphamide-based regimens (RCHOP/RCVP) have pooled various histologies of indolent B-cell lymphomas. We examined real-life outcomes of older patients with follicular (FL), mantle cell (MCL), or marginal zone/lymphoplasmacytic lymphoma (MZL/LPL), treated with these first-line regimens. We identified Medicare beneficiaries with FL, MCL, or MZL/LPL, who received either first-line BR or RCHOP/RCVP in 2009-2016, and matched groups using a propensity score. Outcomes of claims-based event-free survival (EFS), overall survival (OS), toxicity, secondary cancers, and costs were compared in the aggregate cohort (N = 2736), and in separately matched histology-specific subcohorts. In the aggregate cohort, EFS was better with BR than with RCHOP/RCVP (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.70-0.87). Acute toxicity was lower with BR, including rates of hospitalizations (33% vs 45%), infections (21% vs 30%), cardiovascular events, and transfusions, yet OS did not differ (HR, 1.03; 95% CI, 0.91-1.17) and Medicare spending was higher. There was no difference in the cumulative incidence of secondary cancers (subhazard ratio, 1.11; 95% CI, 0.83-1.48). The EFS advantage of BR was pronounced in MCL (N = 690; HR, 0.64; 95% CI, 0.54-0.76), but less so in FL (N = 1330; HR, 0.83; 95% CI, 0.69-0.98) and absent in MZL/LPL (N = 574; HR, 0.92; 95% CI, 0.73-1.17). Despite improved EFS and lower toxicity, the shift from RCHOP/RCVP to BR in clinical practice did not improve OS for older patients with indolent B-cell lymphomas. Frequent infections and hospitalizations underscore the need for safer treatment approaches in this population. Secondary cancers do not appear to be increased after BR compared with RCHOP/RCVP.
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Affiliation(s)
- Adam J. Olszewski
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - James N. Butera
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - John L. Reagan
- Department of Medicine Alpert Medical School of Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - Jorge J. Castillo
- Division of Hematologic Oncology Dana Farber Cancer Institute Boston Massachusetts
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17
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Ollila TA, Reagan JL, Olszewski AJ. Clinical features and survival of patients with T-cell/histiocyte-rich large B-cell lymphoma: analysis of the National Cancer Data Base. Leuk Lymphoma 2019; 60:3426-3433. [PMID: 31287335 DOI: 10.1080/10428194.2019.1639166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Using data from the National Cancer Data Base, 2010-2015, we examined characteristics and outcomes of T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL, N = 622) relative to unspecified diffuse large B-cell lymphoma (DLBCL-NOS, N = 91,588) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL, N = 2240). Socio-demographic characteristics of patients with THRLBCL resembled more NLPHL than DLBCL-NOS. Five-year overall survival in THRLBCL was 66% (95% confidence interval [CI], 60-71%). Adjusting for clinical and socio-economic covariates, THRLBCL was associated with better survival than DLBCL-NOS (adjusted hazard ratio, 0.80; 95%CI, 0.67-0.94). This association was similar in academic and community hospitals and consistent in a model stratified by the revised International Prognostic Index. Prognostic factors in THRLBCL included age, comorbidity index, and extranodal primary site, but not stage. Adjusted odds of prior NLPHL were 18.2 higher for THRLBCL (95%CI, 7.2-45.7) than DLBCL-NOS. These large-scale epidemiologic data support the relationship between THRLBCL and NLPHL, and suggest improved prognosis with modern rituximab-based immunochemotherapy.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI, USA
| | - John L Reagan
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI, USA
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Lee S, Fujita K, Negoro E, Morishita T, Yamauchi H, Oiwa K, Ueda T, Yamauchi T. The impact of diagnostic wait time on the survival of patients with diffuse large B-cell lymphoma: effect modification by the International Prognostic Index. Br J Haematol 2019; 187:195-205. [PMID: 31247676 DOI: 10.1111/bjh.16078] [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: 03/08/2019] [Accepted: 05/11/2019] [Indexed: 12/09/2022]
Abstract
Despite the importance of a prompt diagnosis to improve cancer patients' survival, little has been reported on diagnostic delay in diffuse large B-cell lymphoma (DLBCL). A single-centre, retrospective study was conducted to examine the association between diagnostic wait time (DWT), the interval from the initial hospital visit to diagnosis, and survival in patients with DLBCL. A total of 193 patients were enrolled from 2007 to 2017 in our institution. A covariate-adjusted Cox proportional hazards model with restricted cubic spline was used to evaluate the impact of DWT on survival, with a subgroup analysis according to the International Prognostic Index (IPI). DWT was not associated with survival in the entire DLBCL population, but the impact of DWT on survival differed between IPI < 3 and ≥ 3; prolongation of DWT steadily exacerbated the prognosis in patients with IPI ≥ 3, whereas there was a patient population with IPI < 3 who had a high mortality rate despite rather early diagnosis. The opposite trend in the effect of DWT on survival between patients with IPI < 3 and ≥ 3 offset survival in all DLBCL patients. DWT had no observable impact on outcomes in the entire DLBCL population, but longer DWT worsened the prognosis, particularly in patients with IPI ≥ 3.
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Affiliation(s)
- Shin Lee
- Department of Haematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kei Fujita
- Department of Haematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Eiju Negoro
- Department of Haematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuji Morishita
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hideaki Yamauchi
- Department of Haematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kana Oiwa
- Department of Haematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takanori Ueda
- Department of Haematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Haematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Ollila TA, Olszewski AJ. Radiation therapy in primary testicular lymphoma: does practice match the standard of care? Leuk Lymphoma 2018; 60:523-526. [PMID: 29966467 DOI: 10.1080/10428194.2018.1480776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas A Ollila
- a Department of Medicine, Alpert Medical School of Brown University , Providence , RI, USA.,b Division of Hematology and Oncology , Rhode Island Hospital , Providence , RI, USA
| | - Adam J Olszewski
- a Department of Medicine, Alpert Medical School of Brown University , Providence , RI, USA.,b Division of Hematology and Oncology , Rhode Island Hospital , Providence , RI, USA
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