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Sadeghipour A, Taha SR, Shariat Zadeh M, Kosari F, Babaheidarian P, Fattahi F, Abdi N, Tajik F. Expression and Clinical Significance of Ki-67, CD10, BCL6, MUM1, c-MYC, and EBV in Diffuse Large B Cell Lymphoma Patients. Appl Immunohistochem Mol Morphol 2024; 32:309-321. [PMID: 38872345 DOI: 10.1097/pai.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) in adults. Although studies regarding the association between the expression of Ki-67, CD10, BCL6, and MUM1 proteins, as well as c-MYC amplification and EBV status with clinicopathologic characteristics have rapidly progressed, their co-expression and prognostic role remain unsatisfactory. Therefore, this study aimed to investigate the association between the expression of all markers and clinicopathologic features and their prognostic value in DLBCL. Also, the co-expression of markers was investigated. METHODS The protein expression levels and prognostic significance of Ki-67, CD10, BCL6, and MUM1 were investigated with clinical follow-up in a total of 53 DLBCL specimens (including germinal center B [GCB] and activated B cell [ABC] subtypes) as well as adjacent normal samples using immunohistochemistry (IHC). Besides, the clinical significance and prognostic value of c-MYC and EBV status were also evaluated through chromogenic in situ hybridization (CISH), and their correlation with other markers was also assessed. RESULTS The results demonstrated a positive correlation between CD10 and BCL6 expression, with both markers being associated with the GCB subtype ( P< 0.001 and P =0.001, respectively). Besides, we observe a statistically significant association between MUM1 protein expression and clinicopathologic type ( P< 0.005) as well as a positive association between c-MYC and recurrence ( P =0.028). Our survival analysis showed that patients who had responded to R-CHOP treatment had better overall survival (OS) and progression-free survival (PFS) than those who did not. CONCLUSION Collectively, this study's results add these markers' value to the existing clinical understanding of DLBCL. However, further investigations are needed to explore markers' prognostic and biological roles in DLBCL patients.
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MESH Headings
- Humans
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Male
- Female
- Middle Aged
- Interferon Regulatory Factors/metabolism
- Interferon Regulatory Factors/genetics
- Proto-Oncogene Proteins c-bcl-6/metabolism
- Proto-Oncogene Proteins c-bcl-6/genetics
- Proto-Oncogene Proteins c-myc/metabolism
- Proto-Oncogene Proteins c-myc/genetics
- Neprilysin/metabolism
- Adult
- Aged
- Ki-67 Antigen/metabolism
- Herpesvirus 4, Human
- Biomarkers, Tumor/metabolism
- Prognosis
- Epstein-Barr Virus Infections
- Aged, 80 and over
- Doxorubicin/therapeutic use
- Immunohistochemistry
- Gene Expression Regulation, Neoplastic
- Vincristine/therapeutic use
- Clinical Relevance
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Affiliation(s)
- Alireza Sadeghipour
- Department of Pathology, School of Medicine, Iran University of Medical Sciences
- Oncopathology Research Center, Iran University of Medical Sciences
| | - Seyed Reza Taha
- Oncopathology Research Center, Iran University of Medical Sciences
| | | | - Farid Kosari
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Babaheidarian
- Department of Pathology, School of Medicine, Iran University of Medical Sciences
| | - Fahimeh Fattahi
- Clinical Research Development Unit of Ayatollah-Khansari Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Navid Abdi
- Department of Pathology, School of Medicine, Iran University of Medical Sciences
| | - Fatemeh Tajik
- Oncopathology Research Center, Iran University of Medical Sciences
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA
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Clavijo ND, Aguirre JCF, del Pilar Agudelo Lopez C, Borda AA, Wills B, Vega GEQ. Aligning outcomes: DLBCL prognosis at a 4th Level University Hospital in Bogotá is comparable to high-income nations, identification of additional prognostic markers for overall survival and relapse. Ecancermedicalscience 2024; 18:1717. [PMID: 39021535 PMCID: PMC11254405 DOI: 10.3332/ecancer.2024.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Diffuse large B-cell lymphoma (DLBCL), a prevalent non-Hodgkin lymphoma subtype, displays diverse clinical outcomes with persistently high mortality and relapse rates, despite treatment advancements. Notably, the Hispanic demographic lacks consideration in existing prognostic indices for DLBCL. Methods A retrospective cohort study encompassing 112 DLBCL patients diagnosed between 2010 and 2020 was conducted at our institution. Patient data, including overall survival (OS), treatment response, and relapse, were analysed. Results With a median age of 65 years and a predominant male population (60.7%), both the International Prognostic Index (IPI) and revised IPI correlated with OS. In multivariate analysis, patients with ki-67 ≥ 60% exhibited higher mortality risk (Hazard Ratio: 2.35, 95% confidence intervals (CI) 1.05-5.27, p = 0.039), even when controlled by IPI category and B2-microglobulin levels. The absence of B symptoms served as a protective factor for relapse (p < 0.01, OR: 0.147, 95% CI 0.058-0.376) when controlling for ki-67, CD5, and IPI. Conclusion Our cohort demonstrated a 5-year OS rate comparable to high-income countries, highlighting the need for tailored prognostic models for Hispanic DLBCL patients. This study identifies easily accessible parameters aligning with regional resource constraints, providing insights into additional prognostic factors for DLBCL in the Hispanic population.
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Affiliation(s)
- Nicolás Duque Clavijo
- Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 no.117– 15 Bogotá DC, Bogotá 110111, Colombia
- https://orcid.org/0009-0009-4553-5168
| | | | - Claudia del Pilar Agudelo Lopez
- Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 no.117– 15 Bogotá DC, Bogotá 110111, Colombia
| | - Andrés Armando Borda
- Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 no.117– 15 Bogotá DC, Bogotá 110111, Colombia
| | - Beatriz Wills
- Universidad de los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Servicios Médicos de Hematología y Cardiología SAS, Bogotá 110111, Colombia
- https://orcid.org/0000-0002-6837-3722
| | - Guillermo Enrique Quintero Vega
- Universidad de los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Servicios Médicos de Hematología y Cardiología SAS, Bogotá 110111, Colombia
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Cristian M, Așchie M, Mitroi AF, Deacu M, Boșoteanu M, Bălțătescu GI, Stoica AG, Nicolau AA, Enciu M, Crețu AM, Caloian AD, Orășanu CI, Poinăreanu I. The impact of MYD88 and PIM1 in mature large B-cell non-Hodgkin lymphomas: Defining element of their evolution and prognosis. Medicine (Baltimore) 2024; 103:e36269. [PMID: 38335426 PMCID: PMC10860999 DOI: 10.1097/md.0000000000036269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 02/12/2024] Open
Abstract
Sequence studies of the entire exome and transcriptome of lymphoma tissues have identified MYD88 and PIM1 as involved in the development and oncogenic signaling. We aimed to determine the frequency of MYD88 and PIM1 mutations, as well as their expressions in conjunction with the clinicopathological parameters identified in mature large B-cell non-Hodgkin lymphomas. The ten-year retrospective study included 50 cases of mature large B-cell lymphoma, diagnosed at the Pathology Department of the Emergency County Hospital of Constanţa and Săcele County Hospital of Brasov. They were statistically analyzed by demographic, clinicopathological, and morphogenetic characteristics. We used a real-time polymerase chain reaction technique to identify PIM1 and MYD88 mutations as well as an immunohistochemical technique to evaluate the expressions of the 2 genes. Patients with lymphoma in the small bowel, spleen, brain, and testis had a low-performance status Eastern Cooperative Oncology Group (P = .001). The Eastern Cooperative Oncology Group performance status represented an independent risk factor predicting mortality (HR = 9.372, P < .001). An increased lactate dehydrogenase value was associated with a low survival (P = .002). The international prognostic index score represents a negative risk factor in terms of patient survival (HR = 4.654, P < .001). In cases of diffuse large B-cell lymphoma (DLBCL), immunopositivity of MYD88 is associated with non-germinal center B-cell origin (P < .001). The multivariate analysis observed the association between high lactate dehydrogenase value and the immunohistochemical expression of PIM1 or with the mutant status of the PIM1 gene representing negative prognostic factors (HR = 2.066, P = .042, respectively HR = 3.100, P = .004). In conclusion, our preliminary data suggest that the oncogenic mutations of PIM1 and MYD88 in our DLBCL cohort may improve the diagnosis and prognosis of DLBCL patients in an advanced stage.
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Affiliation(s)
- Miruna Cristian
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Mariana Așchie
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
- Academy of Medical Sciences, Bucharest, Romania
- Academy of Romanian Scientists, Bucharest, Romania
| | - Anca-Florentina Mitroi
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Mariana Deacu
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Mădălina Boșoteanu
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Gabriela-Izabela Bălțătescu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Andreea-Georgiana Stoica
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanta, Constanța, Romania
- Department of Hematology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Anca-Antonela Nicolau
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Manuela Enciu
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Ana-Maria Crețu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Andreea-Daniela Caloian
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Department of Hemato-Oncology, “Ovidius” Clinical Hospital, Constanta, Romania
| | - Cristian-Ionuț Orășanu
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology – CEDMOG, “Ovidius” University of Constanta, Constanța, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Ionuț Poinăreanu
- Faculty of Medicine, “Ovidius” University of Constanta, Constanța, Romania
- Department of Pathology, Săcele Municipal Hospital, Brasov, Romania
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Kumi DD, Deenadayalan V, Odoi SM, Aryal B, Turk E, Olafimihan A, Obeidat K, Vakil J, Chhabra N, Zia M. Assessing the Impact of Comorbid Hypercalcemia on Inpatient Outcomes of Patients With Diffuse Large B-cell Lymphoma During Admission for Chemotherapy. Cureus 2024; 16:e54769. [PMID: 38524024 PMCID: PMC10961113 DOI: 10.7759/cureus.54769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Diffuse large B-cell lymphoma (DLBCL) may be complicated by hypercalcemia at various stages of treatment. The impact of hypercalcemia on chemotherapy admission outcomes in DLBCL is not well described. Methods In a retrospective analysis, using the National Inpatient Sample database (2018 - 2020), patients with DLBCL admitted for chemotherapy were dichotomized based on the presence of hypercalcemia. Our primary outcome was all-cause mortality. Secondary outcomes included length of stay (LOS), total charge, rate of acute kidney injury (AKI), tumor lysis syndrome (TLS), hyperkalemia, metabolic acidosis, acute encephalopathy, septic shock, Clostridiodes difficile infection, acute respiratory failure, and venous thromboembolic events (VTE). Results We identified 78,955 patients, among whom 1,375 (1.74%) had hypercalcemia. Hypercalcemia was associated with higher odds of all-cause mortality (aOR:3.05, p-value:0.020), TLS (aOR:8.81, p-value<0.001), acute metabolic encephalopathy (aOR:4.89, p-value<0.001), AKI (aOR:5.29, p-value<0.001), hyperkalemia (aOR:2.84, p-value:0.002), metabolic acidosis (aOR:3.94, p-value<0.001) and respiratory failure (aOR:2.29, p-value:0.007) and increased LOS by 1 day and total charge by 12, 501 USD. Conclusions In patients with DLBCL admitted for inpatient chemotherapy, those with hypercalcemia compared to a cohort without had higher odds of; all-cause mortality, TLS, AKI, acute encephalopathy, acute metabolic acidosis, hyperkalemia, and acute respiratory failure as well as higher LOS and total charge.
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Affiliation(s)
- Dennis D Kumi
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | | | - Samuel M Odoi
- Medicine, Kreiskrankenhaus Bergstrasse GmbH, Heppenheim, DEU
| | - Badri Aryal
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Ekrem Turk
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Ayobami Olafimihan
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Khaldun Obeidat
- Internal Medicine, John H. Stroger, Jr Hospital of Cook County, Chicago, USA
| | - Jay Vakil
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Navika Chhabra
- Hematology/Oncology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Maryam Zia
- Hematology/Oncology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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Garg M, Puckett J, Kamal-Bahl S, Raut M, Ryland KE, Doshi JA, Huntington SF. Real-world treatment patterns, survival, health resource use and costs among Medicare beneficiaries with diffuse large B-cell lymphoma. Future Oncol 2024; 20:317-328. [PMID: 38050764 DOI: 10.2217/fon-2023-0191] [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] [Indexed: 12/06/2023] Open
Abstract
Aim: To examine real-world treatment patterns, survival, healthcare resource use and costs in elderly Medicare beneficiaries with diffuse large B-cell lymphoma (DLBCL). Methods: 11,880 Medicare patients aged ≥66 years with DLBCL between 1 October 2015 and 31 December 2018 were followed for ≥12 months after initiating front-line treatment. Results: Two-thirds (61.2%) of the patients received standard-of-care R-CHOP as first-line treatment. Hospitalization was common (57%) in the 12-months after initiation of 1L treatment; the mean DLCBL-related total costs were US$84,416 during the same period. Over a median follow-up of 2.1 years, 17.8% received at least 2L treatment. Overall survival was lower among later lines of treatment (median overall survival from initiation of 1L: not reached; 2L: 19.9 months; 3L: 9.8 months; 4L: 5.5 months). Conclusion: A large unmet need exists for more efficacious and well-tolerated therapies for older adults with DLBCL.
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Affiliation(s)
- Mahek Garg
- Merck & Co., Inc., Rahway, NJ 07065, USA
| | | | | | | | | | - Jalpa A Doshi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Scott F Huntington
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT 06510, USA
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Cho JY, Jang SC, Kang DW, Lee EK, Koh H, Yoon DH, Park MH. A nationwide analysis of the treatment patterns, survival, and medical costs in Korean patients with relapsed or refractory diffuse large B-cell lymphoma. Front Oncol 2024; 14:1282323. [PMID: 38361777 PMCID: PMC10867264 DOI: 10.3389/fonc.2024.1282323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Background Approximately one-third of patients with diffuse large B-cell lymphoma (DLBCL) are refractory to treatment or experience relapse after initial therapy. Unfortunately, treatment options for older patients and those who experience relapse or become refractory to hematopoietic stem cell transplantation (HSCT) are limited. This nationwide population-based study aimed to identify treatment patterns, survival times, and treatment costs in patients with relapsed/refractory DLBCL (R/R DLBCL). Materials and methods Between 2011 and 2020, data on patients with R/R DLBCL were retrieved from the Korean Health Insurance Review & Assessment Service, encompassing the entire population. We identified the treatment patterns for each treatment line using a Sankey diagram and calculated the median time to the subsequent treatment in line. Median overall and progression-free survival times were estimated using the Kaplan-Meier survival curves. Finally, the medical costs incurred during DLBCL treatment were calculated for each treatment line and the costs related to HSCT were summarized at the episode level. Results A total of 864 patients with R/R DLBCL who received second-line treatment were identified, and a regimen of ifosfamide, carboplatin, and etoposide (ICE) was administered the most. Among them, 353 were refractory or relapsed cases that were treated with third-line treatments. The median times for second-line to third-line, third-line to fourth-line, fourth-line to fifth-line, and fifth-line to sixth-line treatment failures gradually decreased (3.93, 2.86, 1.81, and 1.38 months, respectively). The median overall survival time was 8.90 and 4.73 months following the second-line and third-line treatments, respectively. In the third-line treatment setting, the patients did not show a significant difference in survival time after HSCT. The median medical cost was $39,491 across all treatment lines including the cost of HSCT which was $22,054. Conclusion The treatment patterns in patients with R/R DLBCL, especially at third-line treatments and thereafter, were complicated, and their prognosis was poor despite the high medical costs. Novel and effective treatment options are expected to improve the prognosis and alleviate the economic burden of patients with R/R DLBCL.
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Affiliation(s)
- Jeong-Yeon Cho
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Suk-Chan Jang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Dong-Won Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | | | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
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Gatwood J, Masaquel A, Fox D, Sheinson D, James C, Li J, Hossain F, Ross R. Real-world total cost of care by line of therapy in relapsed/refractory diffuse large B-cell lymphoma. J Med Econ 2024; 27:738-745. [PMID: 38686393 DOI: 10.1080/13696998.2024.2349472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
AIMS There are multiple recently approved treatments and a lack of clear standard-of-care therapies for relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). While total cost of care (TCC) by the number of lines of therapy (LoTs) has been evaluated, more recent cost estimates using real-world data are needed. This analysis assessed real-world TCC of R/R DLBCL therapies by LoT using the IQVIA PharMetrics Plus database (1 January 2015-31 December 2021), in US patients aged ≥18 years treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or an R-CHOP-like regimen as first-line therapy. METHODS Treatment costs and resources in the R/R setting were assessed by LoT. A sensitivity analysis identified any potential confounding of the results caused by the impact of the COVID-19 pandemic on healthcare utilization and costs. Overall, 310 patients receiving a second- or later-line treatment were included; baseline characteristics were similar across LoTs. Inpatient costs represented the highest percentage of total costs, followed by outpatient and pharmacy costs. RESULTS Mean TCC per-patient-per-month generally increased by LoT ($40,604, $48,630, and $59,499 for second-, third- and fourth-line treatments, respectively). Costs were highest for fourth-line treatment for all healthcare resource utilization categories. Sensitivity analysis findings were consistent with the overall analysis, indicating results were not confounded by the COVID-19 pandemic. LIMITATIONS There was potential misclassification of LoT; claims data were processed through an algorithm, possibly introducing errors. A low number of patients met the inclusion criteria. Patients who switched insurance plans, had insurance terminated, or whose enrollment period met the end of data availability may have had truncated follow-up, potentially resulting in underestimated costs. CONCLUSION Total healthcare costs increased with each additional LoT in the R/R DLBCL setting. Further improvements of first-line treatments that reduce the need for subsequent LoTs would potentially lessen the economic burden of DLBCL.
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Affiliation(s)
- Justin Gatwood
- College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - David Fox
- Genentech, Inc, South San Francisco, CA, USA
| | | | | | - Jia Li
- Genentech, Inc, South San Francisco, CA, USA
| | | | - Ryan Ross
- Genesis Research LLC, Hoboken, NJ, USA
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Assis-Mendonça GR, Campos LG, Delamain MT, de Brito ABC, Fanelli MF, Soares FA, de Souza CA, Vassallo J, Lima CSP. Association of single nucleotide variants in VEGFA and KDR with the risk and angiogenic features of diffuse large B-cell lymphoma. Leuk Lymphoma 2023; 64:2165-2177. [PMID: 37647140 DOI: 10.1080/10428194.2023.2248330] [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: 04/28/2023] [Revised: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype and dependent on angiogenesis (AG), whose main effectors are VEGFA and VEGFR2. Functional single nucleotide variants (SNVs) are described in VEGFA and KDR genes. However, it still unknown whether VEGFA - 2578C/A, -2489C/T, -1154G/A, -634G/C, -460C/T and KDR-604T/C, -271G/A, +1192G/A and +1719A/T SNVs act on DLBCL risk and angiogenic features. Genomic DNA from 168 DLBCL patients and 205 controls was used for SNV genotyping. Angiogenesis was immunohistochemically assessed in tumor biopsies, with reactions for VEGFA, VEGFR2, and CD34. VEGFA -1154GG genotype were associated with 1.6-fold higher DLBCL risk. KDR + 1192GG plus KDR + 1719 TT and KDR + 1192GG plus VEGFA - 2578CC combined genotypes are associated with 2.19- and 2.04-fold higher risks of DLBCL, respectively. VEGFA - 634GG or GC genotypes are associated with increased microvessel density and VEGFA levels. No relationship was observed between SNVs and cell-of-origin classification of DLBCL, but higher VEGFA and VEGFR2 were seen in non-germinal center tumors.
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Affiliation(s)
- Guilherme Rossi Assis-Mendonça
- School of Medical Sciences, Laboratory of Cancer Genetics, University of Campinas, Campinas, Brazil
- Young Physician Leaders Program, National Academy of Medicine, Rio de Janeiro, Brazil
| | - Letícia Goulart Campos
- School of Medical Sciences, Laboratory of Cancer Genetics, University of Campinas, Campinas, Brazil
| | | | | | | | - Fernando Augusto Soares
- Instituto D'Or de Pesquisa e Ensino (IDOR), Anatomic Pathology D'Or Hospitals Network, São Paulo, Brazil
| | - Cármino Antônio de Souza
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - José Vassallo
- Instituto D'Or de Pesquisa e Ensino (IDOR), Anatomic Pathology D'Or Hospitals Network, São Paulo, Brazil
- Department of Pathology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carmen Silvia Passos Lima
- School of Medical Sciences, Laboratory of Cancer Genetics, University of Campinas, Campinas, Brazil
- Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Burke JM, Masaquel A, Wang R, Hossain F, Li J, Zhou SQ, Ng CD, Matasar M. Cost of Disease Progression in Diffuse Large B-Cell Lymphoma After Frontline Treatment With Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e393-e404. [PMID: 37704514 DOI: 10.1016/j.clml.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND In recent years, novel agents have become available to treat relapsed/refractory diffuse large B-cell lymphoma (DLBCL); the impact of such agents on treatment costs has not been formally studied. We present results from 2 independent, retrospective, real-world cohort analyses to determine the cost of disease progression after first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). MATERIALS AND METHODS Analyses were conducted using the IQVIA PharMetricsⓇ Plus claims database and the Surveillance, Epidemiology, and End Results registry-Medicare-linked database (SEER-Medicare) and included patients ≥18 years and ≥66 years, respectively. "No progression" was defined as no second-line therapy for ≥2 years after the end of first-line R-CHOP and "treated progression" as initiating a second-line therapy within 2 years following the end of first-line R-CHOP. Analyses were adjusted for baseline covariates, and per-patient-per-month (PPPM) costs were compared between progressors and nonprogressors. RESULTS The IQVIA PharMetrics Plus analysis (January 1, 2010-June 30, 2018) included 871 patients (nonprogressors, n = 725; progressors, n = 146), including 10 patients who received chimeric antigen receptor T-cell therapy (CAR-T). Treated progression was associated with significantly higher adjusted PPPM costs than no progression ($10,554 vs. $1561, P < .001). The SEER-Medicare analysis (January 1, 2010-December 31, 2017) included 4099 patients (nonprogressors, n = 3389; progressors, n = 710), including 12 patients receiving CAR-T. Treated progression was associated with significantly higher adjusted PPPM costs than no progression ($10,928 vs. $2902, P < .001). CONCLUSION Treated progression of DLBCL increases adjusted PPPM costs by over $8000 compared with no progression.
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Affiliation(s)
- John M Burke
- Rocky Mountain Cancer Centers/US Oncology, Aurora, CO.
| | | | | | | | - Jia Li
- Genentech Inc., South San Francisco, CA
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Cristian M, Așchie M, Deacu M, Boșoteanu M, Bălțătescu GI, Stoica AG, Nicolau AA, Poinăreanu I, Orășanu CI. Comparison of Ki67 Proliferation Index in Gastrointestinal Non-Hodgkin Large B-Cell Lymphomas: The Conventional Method of Evaluation or AI Evaluation? Diagnostics (Basel) 2023; 13:2775. [PMID: 37685312 PMCID: PMC10486605 DOI: 10.3390/diagnostics13172775] [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: 08/04/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The most common NHL subtype in SEEU is DLBCL (39%), and it manifests with a variety of cellular morphologies and a high proliferation index. Also, the GI tract is the most common site of extranodal NHLs, and most NHLs involving the GI tract are of B-cell lineage, of which diffuse large B-cell lymphoma is the most common subtype, irrespective of location. The last few years have seen digital pathology as a vital technology that has a positive impact on diagnostics, but studies on the use of DP for lymphoma identification, however, are still restricted to only determining whether a tumor is present or absent. Using the example of cases of malignant NHL, we aim to investigate the diagnostic utility of DP using QuPath software in evaluating the proliferation index and the prognostic significance and to show that improved visualization and analysis contribute to the convergence of these complementary diagnostic modalities for lymphomas. The average proliferation index (Ki67) was 58.33% with values between 10% and 85%. After the stratification of the cases, an increased proliferation index was observed in the majority of cases (53.33%), and this aspect was associated with the advanced age of the patients (p = 0.045). Visual assessment provides lower Ki67 values than automated digital image analysis. However, the agreement coefficient between the conventional method and the AI method indicates an excellent level of reliability (ICC1-0.970, ICC2-0.990). The multivariate analysis revealed that in the cases where the proliferation index Ki67 is high (˃70%), the IPI score represents an important risk factor predicting mortality (HR = 10.597, p = 0.033).
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Affiliation(s)
- Miruna Cristian
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (C.I.O.)
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Institute of Doctoral Studies, School of Medicine, ”Ovidius” University, 900573 Constanta, Romania
| | - Mariana Așchie
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Academy of Medical Sciences, 030171 Bucharest, Romania
| | - Mariana Deacu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (C.I.O.)
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Mădălina Boșoteanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (C.I.O.)
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Gabriela Izabela Bălțătescu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Andreea Georgiana Stoica
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (C.I.O.)
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Department of Hematology, ”Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Anca Antonela Nicolau
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
| | - Ionuț Poinăreanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (C.I.O.)
- Department of Pathology, Săcele Municipal Hospital, 505600 Brașov, Romania
| | - Cristian Ionuț Orășanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (C.I.O.)
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Institute of Doctoral Studies, School of Medicine, ”Ovidius” University, 900573 Constanta, Romania
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11
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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: 2] [Impact Index Per Article: 2.0] [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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12
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Seyedin R, Snider JT, Rajagopalan K, Wade SW, Gergis U. Chimeric antigen receptor T-cell treatment patterns in relapsed or refractory large B-cell lymphoma. Future Oncol 2023; 19:1535-1547. [PMID: 37578377 DOI: 10.2217/fon-2023-0140] [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] [Indexed: 08/15/2023] Open
Abstract
Aim: To investigate real-world chimeric antigen receptor (CAR) T-cell therapy treatment patterns. Patient & methods: Relapsed/refractory large B-cell lymphoma patients who received CAR T-cell therapy were identified. Patient characteristics, setting of CAR T-cell infusion, incidence of CAR T-cell therapy-associated adverse events and healthcare resource utilization were assessed. Results: Of 1175 patients, 83% were infused inpatient. Within three days postinfusion, inpatient-infused patients had a significantly higher risk of CAR T-associated adverse events (hazard ratio: 2.67; 95% CI: 2.09-3.42) compared with outpatient-infused patients. By day 30, 67% of outpatient-infused patients were hospitalized at least once. Conclusion: These findings suggest that physicians were able to select lower-risk patients for outpatient infusion, but postinfusion hospitalizations still occur.
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Affiliation(s)
| | | | | | - Sally W Wade
- Wade Outcomes Research & Consulting, Salt Lake City, UT 84103, USA
| | - Usama Gergis
- Division of Hematology & Oncology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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13
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Borchmann P, Heger JM, Mahlich J, Papadimitrious MS, Riou S, Werner B. Healthcare Resource Utilization and Associated Costs of German Patients with Diffuse Large B-Cell Lymphoma: A Retrospective Health Claims Data Analysis. Oncol Ther 2023; 11:65-81. [PMID: 36447041 PMCID: PMC9935789 DOI: 10.1007/s40487-022-00211-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin's lymphoma with increasing prevalence. Although the disease burden associated with DLBCL is high, only limited data on healthcare resource utilization (HCRU) and associated costs of German patients with DLBCL is available. METHODS Using a large claims database of the German statutory health insurance with 6.7 million enrollees, we identified patients who were newly diagnosed with DLBCL between 2011 and 2018 (index date). Treatment lines were identified based on a predefined set of medication. HCRU and related costs were collected for the entire post index period and per treatment line. RESULTS A total of 2495 incident DLBCL patients were eligible for the analysis. The average follow-up time after index was 41.7 months. During follow-up, 1991 patients started a first-line treatment, 868 a second-line treatment, and 354 a third-line treatment. Overall, patients spent on average (SD) 5.24 (6.17) days per month in hospital after index. While on anti-cancer treatment, this number increased to nine (10.9) in first-line, 8.7 (13.7) in second-line, and 9.4 (15.8) in third-line treatments. Overall costs per patient per month (PPPM) increased from €421 (875.70) before to €3695 (4652) after index. While on a treatment line, PPPM costs were €17,170 (10,246) in first-line, €13,362 (12,685) in second-line, and €12,112 (16,173) in third-line treatments. Time-unadjusted absolute costs sum up to €59,868 (43,331), €35,870 (37,387), and €28,832 (40,540) during first-line, second-line, and third-line treatments, respectively. The main cost drivers were hospitalizations (71% of total costs) and drug acquisition costs (18% of total costs). CONCLUSIONS The financial burden of DLBCL in Germany is high, mainly due to hospitalization and drug costs. Therefore, there is a high medical need for new cost-effective therapeutic options that can lower the disease burden and remain financially viable to support the growing number of patients with this aggressive disease.
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Affiliation(s)
- Peter Borchmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Kerpener Str. 60, 50937, Cologne, Germany
| | - Jan-Michel Heger
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Kerpener Str. 60, 50937, 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 GmbH, Rellinghauser Str. 93, 45128, Essen, Germany
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Matasar M, Masaquel A, S Ho R, Launonen A, Ng CD, Wang R, Fox D, Hossain F, Li J, Burke JM. US cost-effectiveness analysis of polatuzumab vedotin in previously untreated diffuse large B-cell lymphoma. J Med Econ 2023; 26:1134-1144. [PMID: 37674384 DOI: 10.1080/13696998.2023.2254640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
AIMS We evaluated the pharmacoeconomic value of polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) in previously untreated diffuse large B-cell lymphoma (DLBCL) versus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). MATERIALS AND METHODS A 3-state partitioned survival model was used to estimate life years (LYs), quality-adjusted LYs (QALYs), and cost impacts of Pola-R-CHP versus R-CHOP. Analyses utilized mixture-cure survival modelling, assessed a lifetime horizon, discounted all outcomes at 3% per year, and examined both payer and societal perspectives. Progression-free survival, overall survival (OS), drug utilization, treatment duration, adverse reactions, and subsequent treatment inputs were based on data from the POLARIX study (NCT03274492). Costs included drug acquisition/administration, adverse reaction management, routine care, subsequent treatments, end-of-life care, and work productivity. RESULTS Incremental cost-effectiveness ratios of Pola-R-CHP versus R-CHOP were $70,719/QALY gained and $88,855/QALY gained from societal and payer perspectives, respectively. The $32,824 higher total cost of Pola-R-CHP versus R-CHOP was largely due to higher drug costs ($122,525 vs $27,694), with cost offsets including subsequent treatment (-$52,765), routine care (-$1,781), end-of-life care (-$383), and work productivity (-$8,418). Pola-R-CHP resulted in an increase of 0.47 LYs and 0.46 QALYs versus R-CHOP. Pola-R-CHP was cost-effective in 60.9% and 58.0% of simulations at a willingness-to-pay threshold of $150,000/QALY gained from societal and payer perspectives, respectively. LIMITATIONS There was uncertainty around the OS extrapolation in the model, and costs were derived from different sources. Recommended prophylactic medications were not included; prophylactic use of granulocyte colony-stimulating factor for all patients was assumed to be equal across treatment arms in POLARIX. Work productivity loss was estimated from a general population and was not specific to patients with DLBCL. CONCLUSION Pola-R-CHP was projected to be cost-effective versus R-CHOP in previously untreated DLBCL, suggesting that Pola-R-CHP represents good value relative to R-CHOP in this setting.
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Affiliation(s)
- Matthew Matasar
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | | | - Carmen D Ng
- Genentech, Inc, South San Francisco, CA, USA
| | | | - David Fox
- Genentech, Inc, South San Francisco, CA, USA
| | | | - Jia Li
- Genentech, Inc, South San Francisco, CA, USA
| | - John M Burke
- Rocky Mountain Cancer Centers/US Oncology, Aurora, CO, USA
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15
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Moertl B, Dreyling M, Schmidt C, Hoster E, Schoel W, Bergwelt-Baildon MV, Berger K. Inpatient treatment of relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL): A health economic perspective. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:474-482. [PMID: 35033478 DOI: 10.1016/j.clml.2021.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/03/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Patients with relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) require highly individualized therapies. Limited information exists regarding inpatient treatment patterns, outcomes, resource-use, and costs from the perspective of third-party payers in Germany. The aim of this study was to collect and evaluate routine inpatient care data to fill aforementioned gaps. METHODS Retrospective single center observational study in a German tertiary teaching hospital. Data were collected from patient records, the hospital-pharmacy database, and claims data. RESULTS Eighty-four patients (47 male; mean age at initial diagnosis, 59 years) were identified and grouped by treatment line (L): 2L (n = 78), 3L (n = 32), and >3L (n = 12). Prescribed treatments in 2L were chemotherapy 56%, auto-SCT 31%, allo-SCT 1%, other 12%; 3L: 50%, 16%, 6%, 28%, respectively, and >3L: 42%, 0%, 33%, 25%, respectively. Mean number of hospital admissions and length of inpatient stay (days) were: 2L (4, 44), 3L (2, 26), and >3L (5, 63). Average cost/patient: 2L = 44,750€, 3L = 32,589€ and >3L = 88,668€. Mean treatment costs per patient for stem-cell-transplanted patients were 55,468€ for autologous SCT (n = 28) and 131,264€ for allogeneic SCT (n = 7). Documented death was 21%, 28%, and 41% for 2L, 3L, and >3L, respectively. CONCLUSION Individualized DLBCL treatment in patients ≥ 2L is costly and results in a huge variability in resource consumption. The number of documented deaths and length of hospitalization signal a high economic burden on patients and families. A multicenter comprehensive evaluation of health and economic burdens of r/r DLBCL and linkage with other data sources (eg, registries, payers' claims data) is essential.
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Affiliation(s)
- Bernhard Moertl
- Department of Medicine III; Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Martin Dreyling
- Department of Medicine III; Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Christian Schmidt
- Department of Medicine III; Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Eva Hoster
- Department of Medicine III; Ludwig-Maximilian-University Hospital, Munich, Germany; Institute of Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilian-University Munich, Germany
| | - Wolfgang Schoel
- Department Commercial Controlling, Ludwig-Maximilian-University Hospital, Munich, Germany
| | | | - Karin Berger
- Department of Medicine III; Ludwig-Maximilian-University Hospital, Munich, Germany; Institute of Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilian-University Munich, Germany.
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Tsutsué S, Makita S, Yi J, Crawford B. Cost drivers associated with diffuse large B-cell lymphoma (DLBCL) in Japan: A structural equation model (SEM) analysis. PLoS One 2022; 17:e0269169. [PMID: 35622820 PMCID: PMC9140275 DOI: 10.1371/journal.pone.0269169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/16/2022] [Indexed: 11/26/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin’s lymphoma of increasing prevalence in Japan. However, patients with relapsed or refractory disease to first line treatment (rrDLBCL) have been found to shoulder greater economic burden and have poor survival with subsequent lines of therapy. The relative impact of individual patient attributes on total medical cost among patients with rrDLBCL receiving second or third line (2L/3L) therapy was assessed. Structural equation modelling was used to identify potential cost drivers of total medical costs incurred by treatment and procedures in a Japanese retrospective claims database. From the database, rrDLBCL patients on 2L or 3L of treatment were grouped into respective cohorts. The mean [median] (SD) total medical cost of care for the 2L cohort was 73,296.40 [58,223.11] (58,409.79) US dollars (USD) and 75,238.35 [60,477.31] (59,583.66) USD for the 3L cohort. The largest total effect on medical cost in both cohorts was length of hospital stay (LOS) (β: 0.750 [95%CI: 0.728, 0.772] vs β: 0.762 [95%CI: 0.729, 0.794]). Length of hospital stay and potential heart disease complications due to line of treatment were the primary drivers of total cost for patients who had received at least 2L or 3L therapy for rrDLBCL.
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Affiliation(s)
- Saaya Tsutsué
- Celgene K.K., a Bristol Myers Squibb Company, Tokyo, Japan
- * E-mail:
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Snider JT, McMorrow D, Song X, Diakun D, Wade SW, Cheng P. Burden of Illness and Treatment Patterns in Second-line Large B-cell Lymphoma. Clin Ther 2022; 44:521-538. [PMID: 35241295 DOI: 10.1016/j.clinthera.2022.02.004] [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: 06/02/2021] [Revised: 11/23/2021] [Accepted: 02/05/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study examined real-world treatment patterns with curative intent, adverse events, and health care resource utilization and costs in patients with relapsed or refractory large B-cell lymphoma (LBCL) to understand the unmet medical need in the United States. METHODS Adult patients with ≥2 LBCL diagnoses between January 1, 2012, and March 31, 2019, were identified (index date was the date of the earliest LBCL diagnosis) from MarketScan® Commercial and Medicare Supplemental Databases. Patients had ≥1 claim for any LBCL treatment, ≥6 months of data before (baseline) and ≥12 months of data after (follow-up period) the index date, and no baseline LBCL diagnosis. Treatment patterns, adverse events, and all-cause and LBCL-related health care resource utilization and costs were examined. All patients had received first-line therapy of cyclophosphamide, doxorubicin, vincristine, and prednisone with or without rituximab; etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride with or without rituximab; or regimens with anthracycline and second-line therapy with stem cell transplant (SCT)-intended intensive therapy or platinum-based chemotherapy. Patients who received an SCT-intended second-line regimen or received an SCT regardless of second-line regimen were considered SCT eligible. FINDINGS A total of 188 patients met the criteria of eligibility for SCT. Among the 119 patients who received a second-line regimen intended for SCT, only 22.7% received an SCT. Patients eligible for SCT started first-line therapy within 1 month of their LBCL index date, and the mean duration of first-line therapy was 4.1 months. The mean gap in therapy between first- and second-line therapy was 6.6 months, and the mean duration of second-line therapy was 3.0 months. During the second-line therapy treatment window (mean duration with SCT, 12.4 months; mean duration without SCT, 4.8 months), the most common regimens for patients eligible for SCT were ifosfamide, carboplatin, and etoposide with or without rituximab and gemcitabine and oxaliplatin with or without rituximab; the top 4 most common treatment-related adverse events were febrile neutropenia (56.4%), anemia (49.5%), thrombocytopenia (42.6%), and nausea and vomiting (36.2%), which were similar regardless of receipt of SCT; mean (SD) per-patient-per-month all-cause costs were $46,174 ($49,057) for patients with SCT and $45,780 ($52,813) for patients without SCT. IMPLICATIONS Treatment patterns among patients with relapsed or refractory LBCL eligible for SCT were highly varied. Only 22.7% of patients who received an SCT-preparative regimen ultimately received SCT, which highlights the magnitude of unmet needs in this population. The occurrence of treatment-related adverse events was similar regardless of SCT status. Per-patient-per-month all-cause costs were also similar with upfront SCT costs averaged during a longer follow-up.
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Affiliation(s)
| | | | - Xue Song
- IBM Watson Health, Cambridge, Massachusetts
| | | | - Sally W Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Paul Cheng
- Kite, A Gilead Company, Santa Monica, California
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Kilgore KM, Mohammadi I, Wong AC, Snider JT, Cheng P, Schroeder A, Patel AR. Burden of illness and outcomes in second-line large B-cell lymphoma treatment: real-world analysis of Medicare beneficiaries. Future Oncol 2021; 17:4837-4847. [PMID: 34645318 DOI: 10.2217/fon-2021-0607] [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: 11/21/2022] Open
Abstract
Aims: To characterize elderly large B-cell lymphoma patients who progress to second-line treatment to identify potential unmet treatment needs. Patients & methods: Retrospective USA cohort study, patients receiving second-line autologous stem cell transplant (SCT) preparative regimen ('ASCT-intended') versus those who did not; stratified further into those who received a stem cell transplant and those who did not. Primary outcomes were: healthcare resource utilization, costs and adverse events. Results: 1045 patients (22.0%) were included in the ASCT-intended group, 23.3% of whom received SCT (5.1% of entire second-line population). Non-SCT patients were older and had more comorbidities and generally higher rates of healthcare resource utilization and costs. Conclusion: Elderly second-line large B-cell lymphoma patients incurred substantial costs and a minority received potentially curative SCT, suggesting significant unmet need.
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Affiliation(s)
- Karl M Kilgore
- Avalere Health, An Inovalon Company, Washington, DC 20005, USA
| | - Iman Mohammadi
- Avalere Health, An Inovalon Company, Washington, DC 20005, USA
| | - Anny C Wong
- Avalere Health, An Inovalon Company, Washington, DC 20005, USA
| | | | - Paul Cheng
- Kite, A Gilead Company, Santa Monica, CA 90404, USA
| | - Amy Schroeder
- Avalere Health, An Inovalon Company, Washington, DC 20005, USA
| | - Anik R Patel
- Kite, A Gilead Company, Santa Monica, CA 90404, USA
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19
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Xie J, Wu A, Liao L, Nastoupil LJ, Du EX, Noman A, Chen L. Characteristics and treatment patterns of relapsed/refractory diffuse large B-cell lymphoma in patients receiving ≥3 therapy lines in post-CAR-T era. Curr Med Res Opin 2021; 37:1789-1798. [PMID: 34344238 DOI: 10.1080/03007995.2021.1957806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Several novel treatments have been approved for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) since chimeric antigen receptor T-cell (CAR-T) therapy became available. The objective of this study was to describe characteristics and treatment patterns in patients with R/R DLBCL post-CAR-T approval. METHODS Adult patients with R/R DLBCL who initiated third-line treatment or later (3 L+) since 18 October 2017 were identified using administrative claims from IQVIA PharMetrics Plus (1 January 2014-31 March 2020). Treatments were categorized as chemotherapy/chemoimmunotherapy (CT/CIT), targeted therapies, CAR-T and stem cell transplant (SCT). Treatment distribution, treatment duration of CT/CIT and targeted therapies, and initiation of next-line therapy were described for patients receiving 3 L; analyses were repeated for 4 L. RESULTS A total of 145 patients received 3 L between 18 October 2017 and 31 March 2020. Mean age was 57 years, and 34% were female. CT/CIT (44.9%), targeted therapies (26.9%), CAR-T (17.2%) and SCT (11.0%) were administered in 3 L. The median treatment duration was 2.9 months for CT/CIT and targeted therapies combined. 31% of patients initiated 4 L within a median follow-up of 5.8 months. Among patients who received 4 L (N = 55), targeted therapies were most commonly used (36.4%), and the median treatment duration was 2.5 months. CONCLUSIONS Post-CAR-T approval, the majority of patients were treated with CT/CIT or targeted therapies in 3 L and 4 L, though most of the targeted therapies prescribed are not indicated for DLBCL. Treatment duration was short. A high proportion of patients moved to the next line of therapy (LOT) during a short follow-up period. This study highlights the unmet need for more effective treatments for patients with R/R DLBCL in 3 L+.
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Affiliation(s)
- Jipan Xie
- Analysis Group Inc., Los Angeles, CA, USA
| | - Aozhou Wu
- Analysis Group Inc., Los Angeles, CA, USA
| | - Laura Liao
- ADC Therapeutics Inc., New Providence, NJ, USA
| | - Loretta J Nastoupil
- Department of Lymphoma-Myeloma, Division of Cancer Medicine, University of Texas, Houston, TX, USA
| | | | | | - Lei Chen
- ADC Therapeutics Inc., New Providence, NJ, USA
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20
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Kanas G, Ge W, Quek RGW, Keeven K, Nersesyan K, Jon E Arnason. Epidemiology of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) in the United States and Western Europe: population-level projections for 2020-2025. Leuk Lymphoma 2021; 63:54-63. [PMID: 34510995 DOI: 10.1080/10428194.2021.1975188] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) treatments have been rapidly evolving for patients treated in later lines of therapy (LoT). Country-specific cancer registry data for the US and Western Europe (WE) were combined with physician survey results to project the incidence, prevalence, and number of DLBCL and FL patients eligible for and treated by LoT between 2020 and 2025. The total number of incidents and prevalent cases of DLBCL and FL is expected to increase between 2020 and 2025 in the US and WE. 56% and 53% of the third line plus (3L+) eligible DLBCL patients and 60% and 55% of eligible FL patients initiated treatment in the US and WE, respectively. Further research is warranted to understand the reasons behind the high proportion of treatment eligible patients who do not initiate treatment, and potential differences between countries, especially in the 3L + settings.
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Affiliation(s)
| | - Wenzhen Ge
- Regeneron Pharmaceuticals Inc. - Health Economics & Outcomes Research, Tarrytown, NY, USA
| | - Ruben G W Quek
- Regeneron Pharmaceuticals Inc. - Health Economics & Outcomes Research, Tarrytown, NY, USA
| | | | | | - Jon E Arnason
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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21
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Qi CZ, Bollu V, Yang H, Dalal A, Zhang S, Zhang J. Cost-Effectiveness Analysis of Tisagenlecleucel for the Treatment of Patients With Relapsed or Refractory Diffuse Large B-Cell Lymphoma in the United States. Clin Ther 2021; 43:1300-1319.e8. [PMID: 34380609 DOI: 10.1016/j.clinthera.2021.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/03/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the cost-effectiveness and cost-effective price of tisagenlecleucel, a novel, effective chimeric antigen receptor T-cell therapy, versus salvage chemotherapy (SC) for the treatment of relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) using a willingness-to-pay (WTP) threshold of $150,000 per quality-adjusted life year (QALY) gained from a US third-party payer's perspective. METHODS A three-state (progression-free survival, progressive disease, and death), responder-based partitioned survival model with a lifetime horizon and 3% annual discount rate was developed. Overall survival (OS) and progression-free survival of tisagenlecleucel were estimated separately for patients with and without an overall response (OR), using data from JULIET ( Study of Efficacy and Safety of CTL019 in Adult DLBCL Patients). OS of SC was informed by SCHOLAR-1 (Retrospective Non-Hodgkin Lymphoma Research). Mixture cure models were used to inform the survival of tisagenlecleucel responders, supported by JULIET. The median OS was 11.1 months in all tisagenlecleucel-treated patients but not reached for responders; no progression or death occurred among responders since month 22 of treatment. For tisagenlecleucel nonresponders and SC, survival was based on standard parametric models until month 60and the survival of DLBCL long-term survivors thereafter. The model prediction validated well against the observed trial data. Costs and utilities were from the literature; utilities depended on health states and were used to estimate QALYs. Total costs, QALYs, and incremental cost per QALY gained were estimated. A cost-effective price range was estimated for all tisagenlecleucel-treated patients, OR responders, and complete response (CR) responders. Deterministic sensitivity and scenario analyses and a probabilistic sensitivity analysis were performed. All costs were reported in or inflated to 2020 US dollars. FINDINGS Tisagenlecleucel was associated with 3.35 QALYs gained versus SC.,The estimated incremental costs per QALY gained versus SC were $78,652 using the wholesale acquisition cost of $373,000 for tisagenlecleucel. The estimated cost-effective price of tisagenlecleucel in all treated patients was $612,270 at the WTP threshold of $150,000. Tisagenlecleucel OR and CR responders had an increase of 7.82 and 9.34 QALYs versus SC, with cost-effective prices estimated at $1,281,456 and $1,551,974, respectively. Sensitivity analysis results supported the base case findings. IMPLICATIONS Tisagenlecleucel is a cost-effective treatment versus SC for r/r DLBCL from the perspective of a US third-party payer. The estimated cost-effective prices ranged from $612,270 (all tisagenlecleucel-treated patients) to up to $1.5 million (patients achieving CR). Limitations include the use of single-arm trials due to data availability. (Clin Ther. 2021;43:XXX-XXX) © 2021 Elsevier HS Journals, Inc.
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Affiliation(s)
| | - Vamsi Bollu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Anand Dalal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Su Zhang
- Analysis Group, Inc, Boston, MA, USA
| | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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22
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Yang X, Laliberté F, Germain G, Raut M, Duh MS, Sen SS, Lejeune D, Desai K, Armand P. Real-World Characteristics, Treatment Patterns, Health Care Resource Use, and Costs of Patients with Diffuse Large B-Cell Lymphoma in the U.S. Oncologist 2021; 26:e817-e826. [PMID: 33616256 PMCID: PMC8100570 DOI: 10.1002/onco.13721] [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: 05/04/2020] [Accepted: 01/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Diffuse large B‐cell lymphoma (DLBCL) represents the most common subtype of non‐Hodgkin lymphoma in the U.S., but current real‐world data are limited. This study was conducted to describe real‐world characteristics, treatment patterns, health care resource utilization (HRU), and health care costs of patients with treated DLBCL in the U.S. Materials and Methods A retrospective study was conducted using the Optum Clinformatics Data Mart database (January 2013 to March 2018). Patients with an International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis for DLBCL after October 2015 and no prior International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis for unspecified DLBCL or primary mediastinal large B‐cell lymphoma were classified as incident; those with such codes were classified as prevalent. An adapted algorithm identified lines of therapy (e.g., first line [1L]). All‐cause HRU and costs were calculated per‐patient‐per‐year (PPPY) among patients with a ≥1L. Results Among 1,877 incident and 651 prevalent patients with ≥1L, median age was 72 years and 46% were female. Among incident patients, 22.6% had at least two lines (2L), whereas 38.4% of prevalent patients had ≥2L. The most frequent 1L therapy was rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP). Incident patients had 1.3 inpatient and 42.0 outpatient (OP) visits PPPY, whereas prevalent patients had 0.8 and 31.3 visits PPPY, respectively. Total costs were $137,156 and $81,669 PPPY for incident and prevalent patients, respectively. OP costs were the main driver of total costs at $88,202 PPPY, which were higher within the first year. Conclusion This study showed that a large portion of patients require additional therapy after 1L treatment to manage DLBCL and highlighted the substantial economic burden of patients with DLBCL, particularly within the first year following diagnosis. Implications for Practice Patients diagnosed with diffuse large B‐cell lymphoma (DLBCL) carry a substantial clinical and economic burden. A large portion of these patients require additional therapy beyond first‐line treatment. There is significant unmet need among patients with DLBCL who require additional therapy beyond first‐line treatment. Patients who do not respond to first‐line therapy and are not eligible for transplants have very high health care resource utilization and costs, especially in the first 12 months following initiation of treatment. This article describes the real‐world demographic and clinical characteristics, as well as current treatment patterns, among patients diagnosed with diffuse large B‐cell lymphoma (DLBCL) and treated in the United States. Health care resource use and associated costs are assessed.
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Affiliation(s)
| | | | | | - Monika Raut
- Merck & Co., Inc., Kenilworth, New Jersey, USA
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23
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Wang XJ, Wang YH, Li SCT, Gkitzia C, Lim ST, Koh LP, Lim FLWI, Hwang WYK. Cost-effectiveness and budget impact analyses of tisagenlecleucel in adult patients with relapsed or refractory diffuse large B-cell lymphoma from Singapore's private insurance payer's perspective. J Med Econ 2021; 24:637-653. [PMID: 33904359 DOI: 10.1080/13696998.2021.1922066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients experiencing relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) have limited treatment options and poor prognosis. Tisagenlecleucel (TIS) has shown improved clinical outcomes, but at a high upfront cost. Singapore has a multi-payer healthcare system where private insurance is one of the major payers. This study evaluated the cost-effectiveness and budget impact of TIS against salvage chemotherapy regimen (SCR) for treating r/r DLBCL patients who have failed ≥2 lines of systemic therapy from Singapore's private insurance payer's perspective. METHODS Over a life-time horizon, a partitioned survival model with three health-states was developed to evaluate the cost-effectiveness of TIS vs. SCR with or without hematopoietic stem cell transplantation (HSCT). Efficacy inputs for TIS and SCR were based on 43 months of observation data from pooled JULIET and UPenn trials, and CORAL extension studies respectively. Direct costs for pre-treatment, treatment, adverse events, follow-up, subsequent-HSCT, relapse, and terminal care were included. Incremental cost-effectiveness ratios (ICERs) were calculated as the total incremental costs per quality-adjusted life-year (QALY) gained. Additionally, the financial implication of introducing TIS in Singapore from a private payer's perspective was analyzed, comparing the current treatment pathway (without TIS) with a future scenario (with TIS) over 5 years. RESULTS Compared with SCR, TIS was the dominant option, with cost savings of S$8,477 alongside an additional gain of 2.78 QALYs in privately insured patients who shifted from private to public hospitals for TIS treatment. Scenario analyses for patients starting in public hospitals show ICERs of S$99,623 (no subsidy) and S$133,261 (50% subsidy for SCR treatment, no subsidy for TIS), supporting the base case. The projected annual budget impact ranges from S$850,000 to S$3.4 million during the first 5 years. CONCLUSIONS TIS for treating r/r DLBCL patients who have failed ≥2 lines of systemic therapies, is likely to be cost effective with limited budget impact.
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Affiliation(s)
| | - Yi-Ho Wang
- Novartis Singapore Pte Ltd., Singapore, Singapore
| | | | | | - Soon Thye Lim
- National Cancer Centre Singapore, Singapore, Singapore
| | - Liang Piu Koh
- National University Cancer Institute, Singapore, Singapore
| | | | - William Ying Khee Hwang
- National University Cancer Institute, Singapore, Singapore
- Singapore General Hospital, Singapore, Singapore
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24
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Harris LJ, Patel K, Martin M. Novel Therapies for Relapsed or Refractory Diffuse Large B-Cell Lymphoma. Int J Mol Sci 2020; 21:E8553. [PMID: 33202794 PMCID: PMC7698117 DOI: 10.3390/ijms21228553] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 12/04/2022] Open
Abstract
The most common type of non-Hodgkin lymphoma in adults is diffuse large B-cell (DLBCL). There is a historical unmet need for more effective therapies in the 2nd and 3rd line setting. Emerging immunochemotherapies have shown activity in small studies of heavily pre-treated patients with prolonged remissions achieved in some patients. Anti-CD19 CAR (chimeric antigen receptor) T cells are potentially curative in the 3rd line and beyond setting and are under investigation in earlier lines of therapy. Antibody-drug conjugates (ADC's) such as polatuzumab vedotin targeting the pan-B-cell marker CD79b has proven effectiveness in multiply-relapsed DLBCL patients. Tafasitamab (MOR208) is an anti-CD19 monoclonal antibody producing prolonged remissions when combined with Lenalidomide (LEN) in patients who were not candidates for salvage chemotherapy or autologous stem cell transplant. Selinexor, an oral, small-molecule selective inhibitor of XPO1-mediated nuclear export (SINE), demonstrated prolonged activity against heavily-pretreated DLBCL without cumulative toxicity and is being investigated as part of an oral, chemotherapy-free regimen for relapsed aggressive lymphoma. This article reviews current strategies and novel therapies for relapsed/refractory DLBCL.
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Affiliation(s)
- Leonard Jeff Harris
- Oncology Division, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38103, USA;
| | - Kruti Patel
- Oncology Division, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38103, USA;
| | - Michael Martin
- West Cancer Center & Research Institute, Memphis, TN 38103, USA;
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25
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Broder MS, Ma Q, Yan T, Zhang J, Chang E, Kuzan D, Eldjerou L. Economic Burden of Neurologic Toxicities Associated with Treatment of Patients with Relapsed or Refractory Diffuse Large B-Cell Lymphoma in the United States. AMERICAN HEALTH & DRUG BENEFITS 2020; 13:192-199. [PMID: 33343819 PMCID: PMC7741176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T-cell therapy, which is approved for the treatment of relapsed or refractory diffuse large B-cell lymphoma (DLBCL), can be associated with potentially severe and costly neurologic adverse events (AEs). OBJECTIVES To develop an evidence-based list of treatment-related neurologic AEs in patients with relapsed or refractory DLBCL, including AEs related to CAR T-cell therapies, and to estimate the healthcare costs associated with these neurologic AEs in a real-world setting. METHODS We identified grade ≥3 neurologic AEs that occurred in ≥2% of patients by reviewing drug prescribing information and published clinical trials with therapies used for relapsed or refractory DLBCL. Data from 3 nationally representative claims databases were used to identify adults with relapsed or refractory DLBCL, who were eligible for the study if they received 1 of 4 types of therapy, including CAR T-cell therapy, high-intensity cytotoxic therapy, low-intensity cytotoxic therapy, or targeted therapies. The rates of neurologic AEs and total healthcare costs were calculated for patients with and without neurologic AEs within 30 days of treatment. The costs were inflated to 2019 first-quarter US dollars. RESULTS A total of 16 types of neurologic AEs were identified, including 13 events related to CAR T-cell therapy and 5 related to conventional immunochemotherapy regimens, with 2 overlapping event types. Of these AEs, 11 were included in the claims analysis, based on available diagnosis codes. Of the 11,098 adults with relapsed or refractory DLBCL in the study, 118 patients received CAR T-cell therapy, 9483 received a high-intensity cytotoxic therapy, 1259 received a low-intensity cytotoxic therapy, and 238 received a targeted therapy. A total of 299 (2.7%) patients had ≥1 neurologic AEs during the 30-day postindex period. Of these patients, 43 received CAR T-cell therapy (36.4% of the 118 CAR T-cell therapy users). The mean total healthcare cost was $71,982 higher for patients with neurologic AEs than for patients without neurologic AEs. The trend of higher costs in patients with neurologic AEs was consistent across the treatment groups and was most pronounced in CAR T-cell therapy users ($143,309; 95% confidence interval, $5838-$280,779). CONCLUSION Patients with relapsed or refractory DLBCL who had severe or life-threatening neurologic AEs incur substantially higher costs than their counterparts who do not have neurologic AEs, with the largest cost difference in patients who receive CAR T-cell therapy.
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Affiliation(s)
- Michael S Broder
- President, Partnership for Health Analytic Research, Beverly Hills, CA
| | - Qiufei Ma
- Director, Global Value & Access & HEOR Lead, Cell & Gene Therapies Unit, Novartis Pharmaceuticals, East Hanover, NJ
| | - Tingjian Yan
- Director, Health Services Research, Partnership for Health Analytic Research, Beverly Hills
| | - Jie Zhang
- Head, Global Value and Access, Cell and Gene Therapeutics Unit, Novartis Pharmaceuticals, East Hanover
| | - Eunice Chang
- Chief Statistician, Partnership for Health Analytic Research, Beverly Hills
| | - David Kuzan
- Global Medical Director, Novartis Pharmaceuticals, East Hanover
| | - Lamis Eldjerou
- Senior Global Medical Director, Novartis Pharmaceuticals, East Hanover
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26
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Tsutsué S, Tobinai K, Yi J, Crawford B. Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma. PLoS One 2020; 15:e0237509. [PMID: 32810157 PMCID: PMC7444590 DOI: 10.1371/journal.pone.0237509] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/28/2020] [Indexed: 12/14/2022] Open
Abstract
Limited data are available regarding treatment patterns, healthcare resource utilization (HCRU), treatment costs and clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL) in Japan. This retrospective database study analyzed the Medical Data Vision database for DLBCL patients who received treatment during the identification period from October 1 2008 to December 31 2017. Among 6,965 eligible DLBCL patients, 5,541 patients (79.6%) received first-line (1L) rituximab (R)-based therapy, and then were gradually switched to chemotherapy without R in subsequent lines of therapy. In each treatment regimen, 1L treatment cost was the highest among all lines of therapy. The major cost drivers i.e. total direct medical costs until death or censoring across all regimens and lines of therapy were from the 1L regimen and inpatient costs. During the follow-up period, DLBCL patients who received a 1L R-CHOP regimen achieved the highest survival rate and longest time-to-next-treatment, with a relatively low mean treatment cost due to lower inpatient healthcare resource utilization and fewer lines of therapy compared to other 1L regimens. Our retrospective analysis of clinical practices in Japanese DLBCL patients demonstrated that 1L treatment and inpatient costs were major cost contributors and that the use of 1L R-CHOP was associated with better clinical outcomes at a relatively low mean treatment cost.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/economics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Cost-Benefit Analysis
- Cyclophosphamide/economics
- Cyclophosphamide/therapeutic use
- Databases, Factual
- Doxorubicin/economics
- Doxorubicin/therapeutic use
- Female
- Health Care Costs/statistics & numerical data
- Hospitalization/economics
- Hospitalization/statistics & numerical data
- Humans
- Insurance Claim Reporting/statistics & numerical data
- Japan/epidemiology
- Lymphoma, Large B-Cell, Diffuse/economics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Neoadjuvant Therapy/economics
- Neoadjuvant Therapy/statistics & numerical data
- Practice Patterns, Physicians'/economics
- Practice Patterns, Physicians'/statistics & numerical data
- Prednisone/economics
- Prednisone/therapeutic use
- Retrospective Studies
- Rituximab/administration & dosage
- Rituximab/economics
- Rituximab/therapeutic use
- Survival Analysis
- Vincristine/economics
- Vincristine/therapeutic use
- Young Adult
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27
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Tkacz J, Garcia J, Gitlin M, McMorrow D, Snyder S, Bonafede M, Chung KC, Maziarz RT. The economic burden to payers of patients with diffuse large B-cell lymphoma during the treatment period by line of therapy. Leuk Lymphoma 2020; 61:1601-1609. [PMID: 32270727 DOI: 10.1080/10428194.2020.1734592] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We retrospectively analyzed treatment patterns and healthcare costs among patients diagnosed with diffuse large B-cell lymphoma (DLBCL) during each line of therapy (LOT) using data from the IBM® MarketScan® Commercial and Medicare Supplemental Databases from January 2011 to May 2017. Patients were included if they had a diagnosis of DLBCL, ≥12 months of disease-free continuous enrollment prediagnosis, and ≥1 month of postdiagnosis follow-up. Of 2066 eligible patients receiving first-line treatment, 17% (n = 340) received second-line treatment; of these, 23% (n = 77) received third-line treatment. Mean healthcare expenditures (treatment duration) for first, second, and third LOTs were $111,314 (124.5 days), $88,472 (80.8 days), and $103,365 (70.9 days), respectively. When adjusted to 30-day period costs, first, second, and third LOT healthcare expenditures increased to $26,825, $32,857, and $43,854, respectively. Patients with newly diagnosed and relapsed/refractory DLBCL incur a significant cost burden (for payers), and such costs increase as patients proceed through subsequent LOTs.
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Affiliation(s)
- Joseph Tkacz
- Life Sciences Division, IBM Watson Health, Bethesda, MD, USA
| | - Jacob Garcia
- †Global Drug Development, Juno Therapeutics, a Celgene company, Seattle, WA, USA
| | - Mathew Gitlin
- Strategic Health Economics, BluePath Solutions, Los Angeles, CA, USA
| | - Donna McMorrow
- Life Sciences Division, IBM Watson Health, Bethesda, MD, USA
| | - Sophie Snyder
- Strategic Health Economics, BluePath Solutions, Los Angeles, CA, USA
| | | | - Karen C Chung
- †Health Economics & Outcomes Research Group, Juno Therapeutics, a Celgene company, Seattle, WA, USA
| | - Richard T Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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