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Mian H, Seow H, Balitsky AK, Cheung MC, Gayowsky A, Tay J, Wildes TM, McCurdy A, Visram A, Sandhu I, Sutradhar R. A Prognostic Survival Model Incorporating Patient-Reported Outcomes for Transplant-Ineligible Patients With Multiple Myeloma. Oncologist 2024:oyae041. [PMID: 38636951 DOI: 10.1093/oncolo/oyae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/14/2024] [Indexed: 04/20/2024] Open
Abstract
Developing prognostic tools specifically for patients themselves represents an important step in empowering patients to engage in shared decision-making. Incorporating patient-reported outcomes may improve the accuracy of these prognostic tools. We conducted a retrospective population-based study of transplant-ineligible (TIE) patients with multiple myeloma (MM) diagnosed between January 2007 and December 2018. A multivariable Cox regression model was developed to predict the risk of death within 1-year period from the index date. We identified 2356 patients with TIE MM. The following factors were associated with an increased risk of death within 1 year: age > 80 (HR 1.11), history of heart failure (HR 1.52), "CRAB" at diagnosis (HR 1.61), distance to cancer center (HR 1.25), prior radiation (HR 1.48), no proteosome inhibitor/immunomodulatory therapy usage (HR 1.36), recent emergency department (HR 1.55) or hospitalization (HR 2.13), poor performance status (ECOG 3-4 HR 1.76), and increasing number of severe symptoms (HR 1.56). Model discrimination was high with C-statistic of 0.74, and calibration was very good. To our knowledge, this represents one of the first prognostic models developed in MM incorporating patient-reported outcomes. This survival prognostic tool may improve communication regarding prognosis and shared decision-making among older adults with MM and their health care providers.
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Affiliation(s)
- Hira Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Matthew C Cheung
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Jason Tay
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tanya M Wildes
- Department of Medicine, University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA
| | - Arleigh McCurdy
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Alissa Visram
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Irwindeep Sandhu
- Department of Medicine, University of Edmonton, Edmonton, AB, Canada
| | - Rinku Sutradhar
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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2
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Cuker A, Kunkle R, Bercovitz RS, Byrne MT, Djulbegovic B, Haberichter SL, Holter-Chakrabarty J, Lottenberg R, Pai M, Rezende SM, Seftel MD, Silverstein RL, Terrell DR, Cheung MC. Distinguishing ASH Clinical Practice Guidelines from Other Forms of ASH Clinical Advice. Blood Adv 2024:bloodadvances.2023011102. [PMID: 38593461 DOI: 10.1182/bloodadvances.2023011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/12/2024] [Accepted: 03/01/2024] [Indexed: 04/11/2024] Open
Abstract
The American Society of Hematology (ASH) develops a variety of resources that provide guidance to clinicians on the diagnosis and management of blood diseases. These resources include clinical practice guidelines (CPGs) and other forms of clinical advice. While both ASH CPGs and other forms of clinical advice provide recommendations, they differ with respect to the methods underpinning their development, the principal type of recommendations they offer, their transparency and concordance with published evidence, and the time and resources required for their development. It is crucial that end users be aware of the differences between CPGs and other forms of clinical advice and that producers and publishers of these resources use clear and unambiguous terminology to facilitate their distinction. The objective of this article is to highlight similarities and differences between ASH CPGs and other forms of ASH clinical advice and to discuss the implications of these differences for end users.
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Affiliation(s)
- Adam Cuker
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Robert Kunkle
- American Society of Hematology, Washington DC, Washington, United States
| | - Rachel Sara Bercovitz
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | | | | | | | | | | | | | | | - Matthew D Seftel
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Deirdra R Terrell
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Matthew C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Takhar P, Geirnaert M, Gavura S, Beca J, Mercer RE, Denburg A, Muñoz C, Tadrous M, Parmar A, Dionne F, Boehm D, Chambers C, Craig E, Trudeau M, Cheung MC, Houlihan J, McDonald V, Pechlivanoglou P, Taylor M, Wasylenko E, Wranik WD, Chan KKW. Application of Multi-Criteria Decision Analysis (MCDA) to Prioritize Real-World Evidence Studies for Health Technology Management: Outcomes and Lessons Learned by the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration. Curr Oncol 2024; 31:1876-1898. [PMID: 38668044 PMCID: PMC11049582 DOI: 10.3390/curroncol31040141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/09/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Multi-criteria decision analysis (MCDA) is a value assessment tool designed to help support complex decision-making by incorporating multiple factors and perspectives in a transparent, structured approach. We developed an MCDA rating tool, consisting of seven criteria evaluating the importance and feasibility of conducting potential real-world evidence (RWE) studies aimed at addressing uncertainties stemming from initial cancer drug funding recommendations. In collaboration with the Canadian Agency for Drugs and Technologies in Health's Provincial Advisory Group, a validation exercise was conducted to further evaluate the application of the rating tool using RWE proposals varying in complexity. Through this exercise, we aimed to gain insight into consensus building and deliberation processes and to identify efficiencies in the application of the rating tool. An experienced facilitator led a multidisciplinary committee, consisting of 11 Canadian experts, through consensus building, deliberation, and prioritization. A total of nine RWE proposals were evaluated and prioritized as low (n = 4), medium (n = 3), or high (n = 2) priority. Through an iterative process, efficiencies and recommendations to improve the rating tool and associated procedures were identified. The refined MCDA rating tool can help decision-makers prioritize important and feasible RWE studies for research and can enable the use of RWE for the life-cycle evaluation of cancer drugs.
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Affiliation(s)
- Pam Takhar
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
| | | | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
| | - Jaclyn Beca
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
| | - Rebecca E. Mercer
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
- Evaluative Clinical Services, Sunnybrook Research Institute, Toronto, ON M4N 3M3, Canada;
| | - Avram Denburg
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Caroline Muñoz
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
- Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Ambica Parmar
- Division of Medical Oncology & Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada; (A.P.); (M.T.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Darryl Boehm
- Saskatchewan Cancer Agency, Regina, SK S4W 0G3, Canada;
| | | | - Erica Craig
- New Brunswick Cancer Network, Fredericton, NB E3B 5G8, Canada;
| | - Maureen Trudeau
- Division of Medical Oncology & Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada; (A.P.); (M.T.)
| | - Matthew C. Cheung
- Evaluative Clinical Services, Sunnybrook Research Institute, Toronto, ON M4N 3M3, Canada;
- Division of Medical Oncology & Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada; (A.P.); (M.T.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Valerie McDonald
- Independent Patient Representative, Toronto, ON M6G 2V3, Canada;
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | | | - Eric Wasylenko
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Wiesława Dominika Wranik
- Department of Public and International Affairs, Faculty of Management, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Kelvin K. W. Chan
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
- Evaluative Clinical Services, Sunnybrook Research Institute, Toronto, ON M4N 3M3, Canada;
- Division of Medical Oncology & Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada; (A.P.); (M.T.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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4
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Gong IY, Prica A, Ante Z, Calzavara A, Krzyzanowska MK, Singh S, Suleman A, Cheung MC, Crump M. Indolent lymphoma care delivery and outcomes during the COVID-19 pandemic in Ontario, Canada. Br J Haematol 2024; 204:805-814. [PMID: 37886835 DOI: 10.1111/bjh.19166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
The treatment pattern and outcomes in patients with indolent B-cell lymphoma treated during the coronavirus disease 2019 (COVID-19) pandemic period compared to the prepandemic period are unclear. This was a retrospective population-based study using administrative databases in Ontario, Canada (follow-up to 31 March 2022). The primary outcome was treatment pattern; secondary outcomes were death, toxicities, healthcare utilization (emergency department [ED] visit, hospitalization) and SARS-CoV-2 outcomes. Adjusted hazard ratios (aHR) from Cox proportional hazards models were used to estimate associations. We identified 4143 patients (1079 pandemic, 3064 prepandemic), with a median age of 69 years. In both time periods, bendamustine (B) + rituximab (BR) was the most frequently prescribed regimen. During the pandemic, fewer patients received R maintenance or completed the full 2-year course (aHR 0.81, 95% CI 0.71-0.92, p = 0.001). Patients treated during the pandemic had less healthcare utilization (ED visit aHR 0.77, 95% CI 0.68, 0.88, p < 0.0001; hospitalization aHR 0.81, 95% CI 0.70-0.94, p = 0.0067) and complications (infection aHR 0.69, 95% CI 0.57-0.82, p < 0.0001; febrile neutropenia aHR 0.66, 95% CI 0.47-0.94, p = 0.020), with no difference in death. Independent of vaccination, active rituximab use was associated with a higher risk of COVID-19 complications. Despite similar front-line regimen use, healthcare utilization and admissions for infection were less in the pandemic cohort.
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Affiliation(s)
- Inna Y Gong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anca Prica
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Zharmaine Ante
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Andrew Calzavara
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Simron Singh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Adam Suleman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Michael Crump
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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5
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Arya S, Mozessohn L, Gong I, Faught N, Liu N, Singh S, Chan K, Cheung MC. The impact of marginalization on diffuse large B-cell lymphoma overall survival: a retrospective cohort study. Leuk Lymphoma 2024:1-9. [PMID: 38265355 DOI: 10.1080/10428194.2024.2306463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
The aim of this study was to describe the impact of marginalization on DLBCL overall survival (OS) within the Canadian setting. We conducted a population-based retrospective cohort study of adult patients with newly diagnosed DLBCL in Ontario between 1 January 2005 and 31 December 2017 receiving a rituximab-containing chemotherapy regimen with curative intent followed until 1 March 2020. Our primary exposure of interest was the Ontario Marginalization Index (ON-Marg). The primary outcome was 2-year OS, accounting for patient age, sex, cancer characteristics, comorbidity burden, and rural dwelling status. While two-year overall survival was inferior for individuals in the most deprived marginalization quintile (70.4% Q5 vs. 76.0% Q1), after adjustment for relevant covariates neither the composite ON-Marg nor any of its dimensions had a significant effect. Within the Canadian context, among patients who receive chemotherapy, marginalization may not have a significant association with overall survival when accounting for key patient covariates, lending support for preserved outcomes.
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Affiliation(s)
- Sumedha Arya
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Inna Gong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Simron Singh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Kelvin Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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6
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Cheung MC, Kunkle R, Plovnick R, Lottenberg R, Rezende SM, Silverstein R, Pai M, Seftel M, Cuker A. ASH Clinical Practice Guidelines: strategies to stay up-to-date. Blood Adv 2023; 7:6707-6709. [PMID: 37738156 PMCID: PMC10641472 DOI: 10.1182/bloodadvances.2023011481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Matthew C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Rob Kunkle
- American Society of Hematology, Washington, DC
| | | | - Richard Lottenberg
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Suely M Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Roy Silverstein
- Medical College of Wisconsin and Versiti Blood Research Institute, Milwaukee, WI
| | - Menaka Pai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew Seftel
- University of British Columbia and Canadian Blood Services, Vancouver, BC, Canada
| | - Adam Cuker
- Hematology, University of Pennsylvania, Philadelphia, PA
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Gong IY, Cheung MC, Chan KKW, Arya S, Faught N, Calzavara A, Liu N, Odejide OO, Abel G, Kurdyak P, Raphael MJ, Kuczmarski T, Prica A, Mozessohn L. Mortality among patients with diffuse large B-cell lymphoma and mental disorders: a population-based study. J Natl Cancer Inst 2023; 115:1194-1203. [PMID: 37531271 DOI: 10.1093/jnci/djad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Mental disorders have been reported in patients with diffuse large B-cell lymphoma (DLBCL), but studies examining their association with mortality are lacking. METHODS We conducted a population-based study using linked administrative health-care databases from Ontario, Canada. All patients with DLBCL 18 years of age or older treated with rituximab-based therapy between January 1, 2005, and December 31, 2017, were identified and followed until March 1, 2020. Mental disorders were defined as either preexisting or postdiagnosis (after lymphoma treatment initiation). Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) between mental disorders and 1-year and all-cause mortality while controlling for covariates. RESULTS We identified 10 299 patients with DLBCL. The median age of the cohort was 67 years; 46% of patients were female, and 28% had a preexisting mental disorder. At 1-year follow-up, 892 (9%) had a postdiagnosis mental disorder, and a total of 2008 (20%) patients died. Preexisting mental disorders were not associated with 1-year mortality (adjusted HR = 1.06, 95% confidence interval [CI] = 0.96 to 1.17, P = .25), but postdiagnosis disorders were (adjusted HR = 1.51, 95% CI = 1.26 to 1.82, P = .0001). During a median follow-up of 5.2 years, 2111 (22%) patients had a postdiagnosis mental disorder, and 4084 (40%) patients died. Both preexisting and postdiagnosis mental disorders were associated with worse all-cause mortality (preexisting adjusted HR = 1.12, 95% CI = 1.04 to 1.20, P = .0024; postdiagnosis adjusted HR = 1.63, 95% CI = 1.49 to 1.79, P < .0001). CONCLUSIONS Patients with DLBCL and mental disorders had worse short-term and long-term mortality, particularly those with postdiagnosis mental disorders. Further studies are needed to examine mental health service utilization and factors mediating the relationship between mental disorders and inferior mortality.
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Affiliation(s)
- Inna Y Gong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - Sumedha Arya
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neil Faught
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Centre for Addition and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Michael J Raphael
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Thomas Kuczmarski
- University of Washington Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Anca Prica
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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8
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Gupta A, Hay AE, Crump M, Djurfeldt MS, Zhu L, Cheung MC, Shepherd LE, Chen BE, Booth CM. Contact Days Associated With Cancer Treatments in the CCTG LY.12 Trial. Oncologist 2023; 28:799-803. [PMID: 37226534 PMCID: PMC10485297 DOI: 10.1093/oncolo/oyad128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/18/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND When cancer treatments have similar oncologic outcomes, the number of days with in-person healthcare contact (""contact days'') can help contextualize expected time use with each treatment. We assessed contact days in a completed randomized clinical trial. PATIENTS AND METHODS We conducted a secondary analysis of the CCTG LY.12 RCT that evaluated 2-3 cycles of gemcitabine, dexamethasone, and cisplatin (GDP) vs. dexamethasone, cytarabine, and cisplatin (DHAP) in 619 patients with relapsed/refractory lymphoma prior to stem cell transplant. Primary analyses reported similar response rates and survival. We calculated patient-level "contact days" by analyzing trial forms. The study period was from assignment to progression or transplant. Days without healthcare contact were considered "home days''. We compared measures of contact days across arms. RESULTS The study period was longer in the GDP arm (median 50, vs. 47 days, P = .007). Contact days were comparable in both arms (median 18 vs 19, P = 0.79), but home days were higher in the GDP arm (median 33 vs 28, P < .001). The proportion of contact days was lower in the GDP arm (34%, vs. 38%, P = .009). The GDP arm experienced more contact days related to planned outpatient chemotherapy (median, 10 vs. 8 days), but the DHAP arm experienced many more inpatient contact days (median, 11 vs. 0 days). CONCLUSIONS Measures of time use, such as contact days, can be extracted from RCTs. In LY.12, despite comparable oncologic outcomes, GDP was associated with fewer contact days. Such information can guide decision-making for patients with hematological cancers, who already face significant healthcare contact.
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Affiliation(s)
- Arjun Gupta
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Annette E Hay
- Canadian Cancer Trials Group, Kingston, ON, Canada
- Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Michael Crump
- Canadian Cancer Trials Group, Kingston, ON, Canada
- Division of Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | | | - Liting Zhu
- Canadian Cancer Trials Group, Kingston, ON, Canada
| | - Matthew C Cheung
- Canadian Cancer Trials Group, Kingston, ON, Canada
- Division of Hematology, Odette Cancer Centre, Toronto, ON, Canada
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9
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Suleman A, Aktar SJ, Ante Z, Liu N, Chan KKW, Cheung MC, Prica A. Outcomes of patients with indolent lymphoma treated with bendamustine plus rituximab compared to rituximab plus CVP or CHOP chemoimmunotherapy in Ontario. Br J Haematol 2023; 202:1104-1118. [PMID: 37474340 DOI: 10.1111/bjh.18972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
Bendamustine (B) with rituximab (R) has become the preferred regimen for patients with indolent lymphoma in Ontario, Canada, compared to R with cyclophosphamide, vincristine, prednisone (CVP) or cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). We conducted a propensity-matched retrospective cohort population-based study of patients treated with R-CVP/CHOP from 2005 to 2012 and patients treated with BR from 2013 to 2018. The primary outcome was 5-year overall survival (OS), and secondary outcomes included toxicities and healthcare utilization. The 5-year OS for patients treated with BR (n = 2023) and R-CVP/CHOP (n = 2023) was 80% and 75% respectively. Treatment with BR was associated with improved OS (HR 0.79, 95% CI 0.69-0.91). During the first 9 months, patients treated with BR versus R-CVP/CHOP had a higher number of admissions for infection (22% compared to 17%, p < 0.01) and a higher number of mean ED visits (mean 1.01 ± 1.68 visits vs. 0.85 ± 1.51 visits, p < 0.01). This trend persisted for 3 years. The adjusted 5-year OS for patients 75 years and older did not differ based on treatment regimen (55.5% for BR vs. 55.4% for R-CVP/CHOP). Our study supports the use of BR for patients with indolent lymphoma requiring treatment but suggests increased risk of certain toxicities warranting careful patient selection.
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Affiliation(s)
- Adam Suleman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suriya J Aktar
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Zharmaine Ante
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anca Prica
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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10
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Cheung MC, Parashos P. Current endodontic practice and use of newer technologies in Australia and New Zealand. Aust Dent J 2023; 68:186-196. [PMID: 37382301 DOI: 10.1111/adj.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND This study investigated endodontic clinical preferences, adoption of newer technologies and information sources among dentists and endodontists. METHODS Dental and endodontic society members in Australia and New Zealand were surveyed online regarding their endodontic treatment preferences, armamentarium, information sources and continuing professional education (CPE) attendance. RESULTS Complete responses were received from 71 endodontic specialists or postgraduates (Group E) and 139 general dentists (Group D). Most of Group E used dental operating microscopes (95.8%), endodontic cone-beam computed tomography (CBCT; 98.6%) and calcium silicate-based materials (CSBMs; 97.2%), significantly more (P < 0.001) than Group D (86.3% used loupes, <32% used CBCT for endodontics or CSBMs). Most respondents used dental dam always for endodontics (94.3%), electronic apex locators (EAL; 81.0%) and engine-driven nickel-titanium (NiTi) instruments (91.4%); Group E had more experience with engine-driven NiTi (P < 0.001). Endodontic CPE attendance was highest at dental association programs (P < 0.001) while hands-on NiTi training attendance was highest via commercial companies (P < 0.05). Online information sources were commonly used (38.8% of Group D, 59.2% of Group E). CONCLUSION Dental dam, EAL and engine-driven NiTi were almost universally used. The endodontic group reported high adoption of newer endodontic technologies. Endodontic CPE and information sources should be further surveyed as online engagement evolves. © 2023 Australian Dental Association.
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Affiliation(s)
- M C Cheung
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - P Parashos
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
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11
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Gong IY, Chan KKW, Lipscombe LL, Cheung MC, Mozessohn L. Fracture risk among patients with cancer compared to individuals without cancer: a population-based study. Br J Cancer 2023; 129:665-671. [PMID: 37422530 PMCID: PMC10421906 DOI: 10.1038/s41416-023-02353-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Patients with cancer may be at increased risk of osteoporosis and fracture; however, gaps exist in the existing literature and the association between cancer and fracture requires further examination. METHODS We conducted a population-based cohort study of Ontario patients with cancer (breast, prostate, lung, gastrointestinal, haematologic) diagnosed between January 2007 to December 2018 and 1:1 matched non-cancer controls. The primary outcome was incident fracture (end of follow-up December 2019). Multivariable Cox regression analysis was used to estimate the relative fracture risk with sensitivity analysis accounting for competing risk of death. RESULTS Among 172,963 cancer patients with non-cancer controls, 70.6% of patients with cancer were <65 years old, 58% were female, and 9375 and 8141 fracture events were observed in the cancer and non-cancer group, respectively (median follow-up 6.5 years). Compared to non-cancer controls, patients with cancer had higher risk of fracture (adjusted HR [aHR] 1.10, 95% CI 1.07-1.14, p < 0.0001), which was also observed for both solid (aHR 1.09, 95% CI 1.05-1.13, p < 0.0001) and haematologic cancers (aHR 1.20, 95% CI 1.10-1.31, p < 0.0001). Sensitivity analysis accounting for competing risk of death did not change these findings. CONCLUSIONS Our study indicates that patients with cancer are at modest risk of fractures compared to non-cancer controls.
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Affiliation(s)
- Inna Y Gong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Lorraine L Lipscombe
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- Odette Cancer Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
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12
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Skorupski CP, Cheung MC, Lin Y. Anémie préopératoire dans le contexte d’une intervention chirurgicale importante non urgente. CMAJ 2023; 195:E1059-E1060. [PMID: 37580077 PMCID: PMC10426346 DOI: 10.1503/cmaj.221635-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Clarissa P Skorupski
- Département de médecine (Skorupski), Université de Toronto; Centre de cancérologie Odette (Cheung), Centre des sciences de la santé Sunnybrook; ICES Central (Cheung); Programme diagnostique et thérapeutique de précision (Lin), Centre des sciences de la santé Sunnybrook; Département de médecine de laboratoire et de pathobiologie (Lin), Université de Toronto, Toronto, Ont.
| | - Matthew C Cheung
- Département de médecine (Skorupski), Université de Toronto; Centre de cancérologie Odette (Cheung), Centre des sciences de la santé Sunnybrook; ICES Central (Cheung); Programme diagnostique et thérapeutique de précision (Lin), Centre des sciences de la santé Sunnybrook; Département de médecine de laboratoire et de pathobiologie (Lin), Université de Toronto, Toronto, Ont
| | - Yulia Lin
- Département de médecine (Skorupski), Université de Toronto; Centre de cancérologie Odette (Cheung), Centre des sciences de la santé Sunnybrook; ICES Central (Cheung); Programme diagnostique et thérapeutique de précision (Lin), Centre des sciences de la santé Sunnybrook; Département de médecine de laboratoire et de pathobiologie (Lin), Université de Toronto, Toronto, Ont
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13
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Wilson BE, Hay AE, Chan KKW, Cheung MC, Hanna TP. Augmenting clinical trial economic analysis by linking cancer trial data to administrative data: current landscape and future opportunities. BMJ Open 2023; 13:e073353. [PMID: 37567744 PMCID: PMC10423795 DOI: 10.1136/bmjopen-2023-073353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Economic analyses based on clinical trial data are costly and time consuming, and alternative methods for performing economic analyses should be explored. OBJECTIVE AND METHODS In this perspective, we examine the emerging role of administrative data for economic analyses in cancer. RESULTS Compared with routinely collected clinical trial data, routinely collected administrative data have several strengths including high capture rates for healthcare encounters, less resource utilisation, low rates of misclassification, long follow-up periods and the opportunity to collect data points not traditionally captured in clinical trials. However, there are also limitations including the need for accurate data linkage across multiple databases and systems, the costs and time associated with data linkage, the potential time lag between trial data collection and the availability of administrative data, and limited data on quality of life, toxicity and indirect costs. In this perspective, we identify important barriers and potential solutions to performing economic analyses for oncology using administrative data, and outline strategies to increase research in this field. CONCLUSION The use of routinely collected administrative data sets for economic analyses of clinical trials presents a unique opportunity that could complement and validate economic analyses based on trial-level data.
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Affiliation(s)
- Brooke E Wilson
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Annette E Hay
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kelvin Kar-Wing Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Division of Hematology and Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Division of Hematology and Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
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14
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Everest L, Chen BE, Hay AE, Cheung MC, Chan KKW. Power and sample size calculation for incremental net benefit in cost effectiveness analyses with applications to trials conducted by the Canadian Cancer Trials Group. BMC Med Res Methodol 2023; 23:179. [PMID: 37537545 PMCID: PMC10398980 DOI: 10.1186/s12874-023-01956-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/20/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Historically, a priori power and sample size calculations have not been routinely performed cost-effectiveness analyses (CEA), partly because the absence of published cost and effectiveness correlation and variance data, which are essential for power and sample size calculations. Importantly, the empirical correlation between cost and effectiveness has not been examined with respect to the estimation of value-for-money in clinical literature. Therefore, it is not well established if cost-effectiveness studies embedded within randomized-controlled-trials (RCTs) are under- or over-powered to detect changes in value-for-money. However, recently guidelines (such as those from ISPOR) and funding agencies have suggested sample size and power calculations should be considered in CEAs embedded in clinical trials. METHODS We examined all RCTs conducted by the Canadian Cancer Trials Group with an embedded cost-effectiveness analysis. Variance and correlation of effectiveness and costs were derived from original-trial data. The incremental net benefit method was used to calculate the power of the cost-effectiveness analysis, with exploration of alternative correlation and willingness-to-pay values. RESULTS We identified four trials for inclusion. We observed that a hypothetical scenario of correlation coefficient of zero between cost and effectiveness led to a conservative estimate of sample size. The cost-effectiveness analysis was under-powered to detect changes in value-for-money in two trials, at willingness-to-pay of $100,000. Based on our observations, we present six considerations for future economic evaluations, and an online program to help analysts include a priori sample size and power calculations in future clinical trials. CONCLUSION The correlation between cost and effectiveness had a potentially meaningful impact on the power and variance of value-for-money estimates in the examined cost-effectiveness analyses. Therefore, the six considerations and online program, may facilitate a priori power calculations in embedded cost-effectiveness analyses in future clinical trials.
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Affiliation(s)
- Louis Everest
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Bingshu E Chen
- Department of Public Health Sciences, Canadian Cancer Trials Group, Queen's, University, Kingston, ON, Canada
| | - Annette E Hay
- Department of Public Health Sciences, Canadian Cancer Trials Group, Queen's, University, Kingston, ON, Canada
| | - Matthew C Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
- University of Toronto, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
- University of Toronto, Toronto, ON, Canada.
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada.
- Cancer Care Ontario, Toronto, ON, Canada.
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15
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Fitzpatrick MJ, Sundaram V, Ly A, Abramson JS, Balassanian R, Cheung MC, Cook SL, Falchi L, Frank AK, Gupta S, Hasserjian RP, Lin O, Long SR, Menke JR, Mou E, Reed DR, Ruiz-Cordero R, Volaric AK, Wang L, Wen KW, Xie Y, Zadeh SL, Gratzinger D. Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto-Heme Interinstitutional Collaborative study. Cancer Cytopathol 2023; 131:279-288. [PMID: 36573933 PMCID: PMC10557381 DOI: 10.1002/cncy.22676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/28/2022] [Accepted: 11/01/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Few studies have evaluated diagnostic yield of small volume biopsies (SVB) for the diagnosis and management of follicular lymphoma (FL). METHODS The authors performed a multi-institutional retrospective analysis of SVBs including fine-needle aspiration (FNA) and needle core biopsy (NCB) for initial FL diagnosis and suspected recurrence or transformation of FL. A total of 676 workups beginning with SVB were assessed for the mean number of biopsies per workup, the proportion of workups requiring multiple biopsies, and the proportion with a complete diagnosis including grade, on initial biopsy. RESULTS Compared to workups performed for question transformation/recurrence, those done for initial FL diagnosis were significantly more likely to require multiple biopsies (p < .01), had a higher mean number of biopsies per workup (1.7 vs. 1.1, absolute standardized difference = 1.1), and a lower complete diagnosis rate at initial biopsy (39% vs. 56%). At initial FL diagnosis, NCB +/- FNA was associated with fewer biopsies per workup compared to FNA +/- CB (1.2 vs. 1.9), fewer workups requiring multiple biopsies (23% vs. 83%), and a higher complete diagnosis rate (71% vs. 18%). In contrast, during assessment for transformation/recurrence, NCB and FNA showed a similar mean number of biopsies per workup (1.2 vs. 1.2) and few workups required multiple biopsies (6% vs. 19%). CONCLUSIONS SVB at initial FL diagnosis often required additional biopsies to establish a complete diagnosis. In contrast, when assessing for transformed/recurrent FL, additional biopsies were generally not obtained regardless of SVB type, suggesting that in these clinical settings SVB may be sufficient for clinical decision-making.
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Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy S Abramson
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronald Balassanian
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Matthew C Cheung
- Division of Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen L Cook
- Department of Laboratory Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Lorenzo Falchi
- Department of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Annabel K Frank
- Department of Hematology/Oncology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Srishti Gupta
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Steven R Long
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, The University of Iowa, Iowa City, Iowa, USA
| | - Daniel R Reed
- Section on Hematology/Oncology, Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Ashley K Volaric
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
| | - Linlin Wang
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Yi Xie
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Sara L Zadeh
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
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16
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Skorupski CP, Cheung MC, Lin Y. Preoperative anemia in major elective surgery. CMAJ 2023; 195:E551. [PMID: 37068804 PMCID: PMC10110331 DOI: 10.1503/cmaj.221635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Affiliation(s)
- Clarissa P Skorupski
- Department of Medicine (Skorupski), University of Toronto; Odette Cancer Centre (Cheung), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont.
| | - Matthew C Cheung
- Department of Medicine (Skorupski), University of Toronto; Odette Cancer Centre (Cheung), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont
| | - Yulia Lin
- Department of Medicine (Skorupski), University of Toronto; Odette Cancer Centre (Cheung), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont
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17
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Mozessohn L, Li Q, Liu N, Leber B, Khalaf D, Sabloff M, Christou G, Yee K, Chodirker L, Parmentier A, Siddiqui M, Mamedov A, Zhang L, Liu Y, Earle CC, Cheung MC, Mittmann N, Buckstein R. Impact of Frailty on Health Care Resource Utilization and Costs of Care in Myelodysplastic Syndromes. JCO Oncol Pract 2023; 19:e559-e569. [PMID: 36763927 PMCID: PMC10101507 DOI: 10.1200/op.22.00668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/17/2022] [Accepted: 12/29/2022] [Indexed: 02/12/2023] Open
Abstract
PURPOSE The role of frailty in affecting survival in myelodysplastic syndromes (MDS) is increasingly recognized. Despite this, a paucity of data exists on the association between frailty and other clinically meaningful outcomes including health care resource utilization and costs of care. METHODS We linked the Ontario subset of the prospective Canadian MDS registry (including baseline patient/disease characteristics) to population-based health system administrative databases. Baseline frailty was calculated from the 15-item MDS-specific frailty scale (FS-15). Primary outcomes were public health care utilization and 30-day standardized costs of care (2019 Canadian dollars) determined for each phase of disease (initial, continuation, and terminal phases). Negative binomial regression was used to assess the association between frailty and health care costs with Poisson regression to explore predictors of hospitalization. RESULTS Among 461 patients with complete FS-15 scores, 374 (81.1%) had a hospitalization with a mean length of stay of 10.6 days. Controlling for age, comorbidities, Revised International Prognostic Scoring System, and transfusion dependence, the FS-15 was independently associated with hospitalization during the initial (P = .02) and continuation (P = .01) phases but not the terminal disease phase (P = .09). The mean 30-day standardized cost per patient was $8,499 (median, $6,295; interquartile range, $2,798-$11,996), largely driven by cancer clinic visits and hospitalization. On multivariable analysis, the FS-15 was independently associated with costs of care during the initial disease phase (P = .02). CONCLUSION We demonstrate an association between frailty and clinically meaningful outcomes including hospitalization and costs of care in patients with MDS. Our results suggest that baseline frailty may help to inform patients and physicians of expected outcomes.
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Affiliation(s)
- Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Qing Li
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Ning Liu
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Brian Leber
- Division of Hematology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - Dina Khalaf
- Division of Hematology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Grace Christou
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Karen Yee
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lisa Chodirker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Anne Parmentier
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mohammed Siddiqui
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexandre Mamedov
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Liying Zhang
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ying Liu
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Craig C. Earle
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Matthew C. Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacology and Toxicology and Institute for Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rena Buckstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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18
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Gong IY, Vijenthira A, Powis M, Calzavara A, Patrikar A, Sutradhar R, Hicks LK, Wilton D, Singh S, Krzyzanowska MK, Cheung MC. Association of COVID-19 Vaccination With Breakthrough Infections and Complications in Patients With Cancer. JAMA Oncol 2023; 9:386-394. [PMID: 36580318 PMCID: PMC10020872 DOI: 10.1001/jamaoncol.2022.6815] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/21/2022] [Indexed: 12/30/2022]
Abstract
Importance Patients with cancer are known to have increased risk of COVID-19 complications, including death. Objective To determine the association of COVID-19 vaccination with breakthrough infections and complications in patients with cancer compared to noncancer controls. Design, Setting, and Participants Retrospective population-based cohort study using linked administrative databases in Ontario, Canada, in residents 18 years and older who received COVID-19 vaccination. Three matched groups were identified (based on age, sex, type of vaccine, date of vaccine): 1:4 match for patients with hematologic and solid cancer to noncancer controls (hematologic and solid cancers separately analyzed), 1:1 match between patients with hematologic and patients with solid cancer. Exposures Cancer diagnosis. Main Outcomes and Measures Outcomes occurring 14 days after receipt of second COVID-19 vaccination dose: primary outcome was SARS-CoV-2 breakthrough infection; secondary outcomes were emergency department visit, hospitalization, and death within 4 weeks of SARS-CoV-2 infection (end of follow-up March 31, 2022). Multivariable cumulative incidence function models were used to obtain adjusted hazard ratio (aHR) and 95% CIs. Results A total of 289 400 vaccinated patients with cancer (39 880 hematologic; 249 520 solid) with 1 157 600 matched noncancer controls were identified; the cohort was 65.4% female, and mean (SD) age was 66 (14.0) years. SARS-CoV-2 breakthrough infection was higher in patients with hematologic cancer (aHR, 1.33; 95% CI, 1.20-1.46; P < .001) but not in patients with solid cancer (aHR, 1.00; 95% CI, 0.96-1.05; P = .87). COVID-19 severe outcomes (composite of hospitalization and death) were significantly higher in patients with cancer compared to patients without cancer (aHR, 1.52; 95% CI, 1.42-1.63; P < .001). Risk of severe outcomes was higher among patients with hematologic cancer (aHR, 2.51; 95% CI, 2.21-2.85; P < .001) than patients with solid cancer (aHR, 1.43; 95% CI, 1.24-1.64; P < .001). Patients receiving active treatment had a further heightened risk for COVID-19 severe outcomes, particularly those who received anti-CD20 therapy. Third vaccination dose was associated with lower infection and COVID-19 complications, except for patients receiving anti-CD20 therapy. Conclusions and Relevance In this large population-based cohort study, patients with cancer had greater risk of SARS-CoV-2 infection and worse outcomes than patients without cancer, and the risk was highest for patients with hematologic cancer and any patients with cancer receiving active treatment. Triple vaccination was associated with lower risk of poor outcomes.
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Affiliation(s)
- Inna Y. Gong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abi Vijenthira
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre–University Health Network, Toronto, Ontario, Canada
| | - Melanie Powis
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre–University Health Network, Toronto, Ontario, Canada
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrew Calzavara
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Aditi Patrikar
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lisa K. Hicks
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, St Michael’s Hospital–Unity Health, Toronto Ontario, Canada
| | - Drew Wilton
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Simron Singh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Monika K. Krzyzanowska
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre–University Health Network, Toronto, Ontario, Canada
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Matthew C. Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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19
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Ling Y, Cheung MC, Chan KK, Lofters A, Fox C, Patrikar A, Liu N, Singh S. Primary care utilization for patients with newly diagnosed cancer during the COVID-19 pandemic: a population-based study. BMC Cancer 2022; 22:1133. [PMID: 36333707 PMCID: PMC9636629 DOI: 10.1186/s12885-022-10257-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic greatly impacted primary care and cancer care. We studied how primary care utilization in Ontario, Canada changed for patients who were newly diagnosed with cancer just prior to the COVID-19 pandemic compared to those diagnosed in non-pandemic years. Methods This population-based, retrospective cohort study used linked healthcare databases to compare outcomes for patients with a new malignancy diagnosed within the year prior to the COVID-19 pandemic, between July 1 and September 30, 2019 (COVID-19 cohort) to those diagnosed in the same months in 2018 and 2017 (pre-pandemic cohort). We used Poisson regression models to compare rates of in-person and virtual visits to patients’ usual primary care physician (PCP), emergency department (ED) visits, and hospitalizations, all reported per person-year of follow-up. Results In-person visits to usual PCPs decreased from 4.07/person-year in the pre-pandemic cohort to 2.58 in the COVID-19 cohort (p < 0.0001). Virtual visits to usual PCPs increased from 0.00 to 1.53 (p < 0.0001). Combined in-person and virtual visits to patients’ usual PCPs was unchanged from 4.07 to 4.12 (p = 0.89). The rate of ED visits decreased from 0.99/person-year to 0.88 (p < 0.0001). Non-elective hospitalizations remained unchanged, from 0.49/person-year to 0.47 (p = 0.1675). Conclusion There was a sizeable shift in primary care visits for cancer patients from in-person to virtual during the pandemic, although there was no resultant increase in hospitalizations. This suggests that early in the pandemic, virtual care allowed for continuity in utilization of primary care, though further studies are required to confirm this persisted later in the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10257-4.
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Affiliation(s)
- Ying Ling
- grid.17063.330000 0001 2157 2938Division of Hematology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Matthew C. Cheung
- grid.17063.330000 0001 2157 2938Division of Hematology, Department of Medicine, University of Toronto, Toronto, Canada ,grid.413104.30000 0000 9743 1587Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Canada
| | - Kelvin K.W. Chan
- grid.413104.30000 0000 9743 1587Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Aisha Lofters
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Canada
| | - Colleen Fox
- Person-Centered Care, Ontario Health, Toronto, Canada
| | | | - Ning Liu
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Simron Singh
- grid.413104.30000 0000 9743 1587Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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20
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Habbous S, Tai X, Beca JM, Arias J, Raphael MJ, Parmar A, Crespo A, Cheung MC, Eisen A, Eskander A, Singh S, Trudeau M, Gavura S, Dai WF, Irish J, Krzyzanowska M, Lapointe-Shaw L, Naipaul R, Peacock S, Yeung L, Forbes L, Chan KKW. Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada. JAMA Netw Open 2022; 5:e2225118. [PMID: 35917122 PMCID: PMC9346546 DOI: 10.1001/jamanetworkopen.2022.25118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE In response to an increase in COVID-19 infection rates in Ontario, several systemic treatment (ST) regimens delivered in the adjuvant setting for breast cancer were temporarily permitted for neoadjuvant-intent to defer nonurgent breast cancer surgical procedures. OBJECTIVE To examine the use and compare short-term outcomes of neoadjuvant-intent vs adjuvant ST in the COVID-19 era compared with the pre-COVID-19 era. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study in Ontario, Canada. Patients with cancer starting selected ST regimens in the COVID-19 era (March 11, 2020, to September 30, 2020) were compared to those in the pre-COVID-19 era (March 11, 2019, to March 10, 2020). Patients were diagnosed with breast cancer within 6 months of starting systemic therapy. MAIN OUTCOMES AND MEASURES Estimates were calculated for the use of neoadjuvant vs adjuvant ST, the likelihood of receiving a surgical procedure, the rate of emergency department visits, hospital admissions, COVID-19 infections, and all-cause mortality between treatment groups over time. RESULTS Among a total of 10 920 patients included, 7990 (73.2%) started treatment in the pre-COVID-19 era and 7344 (67.3%) received adjuvant ST; the mean (SD) age was 61.6 (13.1) years. Neoadjuvant-intent ST was more common in the COVID-19 era (1404 of 2930 patients [47.9%]) than the pre-COVID-19 era (2172 of 7990 patients [27.2%]), with an odds ratio of 2.46 (95% CI, 2.26-2.69; P < .001). This trend was consistent across a range of ST regimens, but differed according to patient age and geography. The likelihood of receiving surgery following neoadjuvant-intent chemotherapy was similar in the COVID-19 era compared with the pre-COVID-19 era (log-rank P = .06). However, patients with breast cancer receiving neoadjuvant-intent hormonal therapy were significantly more likely to receive surgery in the COVID-19 era (log-rank P < .001). After adjustment, there were no significant changes in the rate of emergency department visits over time between patients receiving neoadjuvant ST, adjuvant ST, or ST only during the ST treatment period or postoperative period. Hospital admissions decreased in the COVID-19 era for patients who received neoadjuvant ST compared with adjuvant ST or ST alone (P for interaction = .01 for both) in either setting. CONCLUSIONS AND RELEVANCE In this cohort study, patients were more likely to start neoadjuvant ST in the COVID-19 era, which varied across the province and by indication. There was limited evidence to suggest any substantial impact on short-term outcomes.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Xiaochen Tai
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Jaclyn M Beca
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Jessica Arias
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Michael J. Raphael
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ambica Parmar
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea Crespo
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Matthew C Cheung
- Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Simron Singh
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Maureen Trudeau
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Wei Fang Dai
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Jonathan Irish
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rohini Naipaul
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Lyndee Yeung
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Leta Forbes
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Division of Medical Oncology, RS McLaughlin Durham Regional Cancer Centre Lakeridge Health, Oshawa, Ontario, Canada
| | - Kelvin K. W. Chan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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21
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Everest L, Blommaert S, Tu D, Pater JL, Hay A, Cheung MC, Chan KKW. Validating Restricted Mean Survival Time Estimates From Reconstructed Kaplan-Meier Data Against Original Trial Individual Patient Data From Trials Conducted by the Canadian Cancer Trials Group. Value Health 2022; 25:1157-1164. [PMID: 35779942 DOI: 10.1016/j.jval.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/28/2021] [Accepted: 12/01/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The development of novel cancer therapies, including immuno-oncology agents, has increased interest in reconstructed individual patient data (IPD) based restricted mean survival time (RMST) analyses. Additionally, reconstructed IPD-based RMST is recommended in cost-effectiveness analyses when original trial IPD are not available. Nevertheless, recently concerns regarding potential bias of reconstructed-IPD RMST have been presented, because reconstructed-IPD RMSTs have not been validated and previous validation endpoints may not capture the entire Kaplan-Meier (KM) curve, especially the "tail." Our study aims to validate the recommended method of IPD reconstruction by comparing reconstructed IPD- and original trial IPD-based RMST. METHODS Canadian Cancer Trials Group trials from 1990 to 2017 were included. Overall survival and progression-free survival IPD were reconstructed based on published KM curves using the Guyot method. Analysts were blinded to original trial IPD. RMST was calculated at 1 year and over the entire KM curve. Reconstructed-IPD and original trial-IPD (gold-standard) RMSTs were compared for accuracy and predictive error via mean deviation, mean absolute error (MAE), mean percentage bias, and Bland-Altman plots and across KM curve quality (vector traced or bitmapped). RESULTS We identified 39 trials. The mean deviation, MAE, and mean percentage bias of RMST between the reconstructed IPD and original trial IPD were small. In particular, the mean deviation was -0.01 months and -0.04 months, MAE was 0.19 months and 0.24 months, and mean percentage bias was 0.82% and 0.84% in overall survival KM curves in control and experimental arms, respectively. Accuracy was generally not associated with KM curve quality. CONCLUSIONS RMST derived from reconstructed IPD displayed excellent accuracy and predictive error compared with the gold standard. Reconstructed IPD could be used to calculate RMST in lieu of original trial IPD, to facilitate decision making for clinicians, researchers, and policy makers.
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Affiliation(s)
- Louis Everest
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Scott Blommaert
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dongsheng Tu
- Department of Public Health Sciences, Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Joseph L Pater
- Department of Public Health Sciences, Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Annette Hay
- Department of Public Health Sciences, Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Matthew C Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada.
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22
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Silverstein WK, Cheung MC, Lin Y. Vitamin B 12 deficiency. CMAJ 2022; 194:E843. [PMID: 35724997 PMCID: PMC9261952 DOI: 10.1503/cmaj.220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- William K Silverstein
- Department of Medicine (Silverstein, Cheung, Lin), University of Toronto; Division of Medical Oncology & Hematology (Cheung, Lin), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont.
| | - Matthew C Cheung
- Department of Medicine (Silverstein, Cheung, Lin), University of Toronto; Division of Medical Oncology & Hematology (Cheung, Lin), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont
| | - Yulia Lin
- Department of Medicine (Silverstein, Cheung, Lin), University of Toronto; Division of Medical Oncology & Hematology (Cheung, Lin), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont
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23
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Vijenthira A, Mozessohn L, Nagamuthu C, Liu N, Blunt D, Alibhai S, Prica A, Cheung MC. Frailty in Patients With Newly Diagnosed Diffuse Large B-Cell Lymphoma Receiving Curative-Intent Therapy: A Population-Based Study. J Natl Compr Canc Netw 2022; 20:635-642.e9. [PMID: 35714676 DOI: 10.6004/jnccn.2022.7014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objectives of this study were to determine whether frailty is associated with survival in a population-based sample of patients with diffuse large B-cell lymphoma (DLBCL) and to describe the healthcare utilization patterns of frail versus nonfrail patients during treatment. METHODS A retrospective cohort study was conducted using population-based data in Ontario, Canada. Patients aged ≥66 years diagnosed between 2006 and 2017 with DLBCL or transformed follicular lymphoma who received first-line curative-intent chemoimmunotherapy were included. Frailty was defined using a modified version of a generalizable frailty index developed for use with Ontario administrative data. Cox regression was performed to examine the association between frailty and 1-year mortality. RESULTS A total of 5,527 patients were included (median age, 75 years [interquartile range, 70-80 years]; 48% female), of whom 2,699 (49%) were classified as frail. Within 1 year of first-line treatment, 32% (n=868) of frail patients had died compared with 20% (n=553) of nonfrail patients (unadjusted hazard ratio, 1.8; 95% CI, 1.6-2.0; P<.0001). Frail patients had higher healthcare utilization during treatment, with most hospitalizations related to infection and/or lymphoma. In multivariable modeling controlling for age, inpatient diagnosis, number of chemoimmunotherapy cycles received, comorbidity burden, and healthcare utilization, frailty remained independently associated with 1-year mortality (adjusted hazard ratio, 1.5; 95% CI, 1.3-1.7; P<.0001). CONCLUSIONS In a population-based sample of older adult patients with DLBCL receiving front-line curative-intent therapy, half were classified as frail, and their adjusted relative rate of death in the first year after starting treatment was 50% higher than that of nonfrail patients. Frailty seems to be associated with poor treatment tolerance and a higher likelihood of requiring acute hospital-based care.
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Affiliation(s)
- Abi Vijenthira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre.,Department of Medicine, University of Toronto
| | - Lee Mozessohn
- Department of Medicine, University of Toronto.,Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, and.,Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Chenthila Nagamuthu
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ning Liu
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Danielle Blunt
- Division of Hematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; and
| | - Shabbir Alibhai
- Department of Medicine, University of Toronto.,Division of General Internal Medicine and Geriatrics, University Health Network, Toronto, Ontario, Canada
| | - Anca Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre.,Department of Medicine, University of Toronto
| | - Matthew C Cheung
- Department of Medicine, University of Toronto.,Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, and.,Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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24
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Hall M, Krishnanandan VA, Cheung MC, Coburn NG, Haas B, Chan KKW, Raphael MJ. An Evaluation of Sex- and Gender-Based Analyses in Oncology Clinical Trials. J Natl Cancer Inst 2022; 114:1186-1191. [PMID: 35477781 PMCID: PMC9360459 DOI: 10.1093/jnci/djac092] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/17/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate whether sex- and gender-based analyses and proper sex- and gender-terminology were used in oncology trials leading to regulatory drug approval. METHODS The Food and Drug Administration (FDA) Hematology/Oncology Approvals and Safety Notifications page was used to identify all anti-cancer therapies that received FDA approval between 2012 and 2019. The trials used to support FDA-drug approval were collected along with all available supplemental tables and study protocols. Documents were reviewed to determine if there was a plan to analyze results according to sex and gender and to determine if consistent sex and gender terminology were used. RESULTS 128 randomized-controlled trials were identified corresponding to a cancer medicine which received FDA-approval. No study specified how sex and gender were collected or analyzed. No study reported any information on the gender of participants. Sex and gender terminology was used inconsistently at least once in 76% (97/128) of studies. Among the 102 trials for non-sex-specific cancer sites, 89% (91/102) presented disaggregated survival outcome data by sex. No study presented disaggregated toxicity data by sex or gender. CONCLUSION The majority of pivotal clinical trials in oncology fail to account for the important distinction between sex and gender and conflate sex and gender terminology. More rigor in designing clinical trials to include sex and gender based analyses and more care in using sex and gender terms in the cancer literature is needed. These efforts are essential to improve the reproducibility, generalizability, and inclusiveness of cancer research.
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Affiliation(s)
- Mathew Hall
- Department of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vaishali A Krishnanandan
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Canadian Centre of Applied Research in Cancer Control, Canada
| | - Michael J Raphael
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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25
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Gong IY, Vijenthira A, Betschel SD, Hicks LK, Cheung MC. COVID-19 vaccine response in patients with hematologic malignancy: A systematic review and meta-analysis. Am J Hematol 2022; 97:E132-E135. [PMID: 35007350 PMCID: PMC9011569 DOI: 10.1002/ajh.26459] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/25/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Inna Y. Gong
- Department of Medicine University of Toronto Toronto Ontario Canada
| | - Abi Vijenthira
- Department of Medicine University of Toronto Toronto Ontario Canada
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Stephen D. Betschel
- Department of Medicine University of Toronto Toronto Ontario Canada
- Division of Allergy and Immunology St. Michael's Hospital Toronto Ontario Canada
| | - Lisa K. Hicks
- Department of Medicine University of Toronto Toronto Ontario Canada
- Division of Hematology/Oncology St. Michael's Hospital Toronto Ontario Canada
| | - Matthew C. Cheung
- Department of Medicine University of Toronto Toronto Ontario Canada
- Division of Medical Oncology and Hematology Sunnybrook Health Sciences Centre Toronto Ontario Canada
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26
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Brailovski E, Li Q, Liu N, Leber B, Khalaf D, Sabloff M, Christou G, Yee K, Chodirker L, Parmentier A, Siddiqui M, Mamedov A, Zhang L, Liu Y, Earle CC, Cheung MC, Mittmann N, Buckstein RJ, Mozessohn L. The impact of oral hypoglycemics and statins on outcomes in myelodysplastic syndromes. Ann Hematol 2022; 101:1023-1030. [PMID: 35190844 DOI: 10.1007/s00277-022-04802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/15/2022] [Indexed: 11/29/2022]
Abstract
Observational studies suggest an anti-neoplastic effect associated with statins, metformin, and dipeptidyl peptidase-4 inhibitors (DPP4i), while sulfonylureas may have a neutral or detrimental effect. We linked the Ontario subset of a prospective Canadian myelodysplastic syndromes (MDS) registry with provincial administrative databases. We assessed the impact of statin/oral hypoglycemic medication exposure on overall survival (OS) using Cox regression analysis, controlling for comorbidities and sociodemographic factors. Five hundred thirty-three patients aged ≥ 66 years were included: 49.3% used statins, 18.9% used metformin, 9.0% used sulfonylureas, and 6.4% used DPP4i. Three hundred ninety-five patients were lower-risk based on the International Prognostic Scoring System. On univariate analysis, we identified a marginal improvement in OS in the lower-risk group using DPP4i (HR 0.98, 95% CI 0.95-1.00, P = 0.05), while there was no impact on mortality for higher-risk DPP4i users (HR 1.03, CI 0.99-1.07, P = 0.21). There was no mortality difference for statins (HR 1.00, CI 1.00-1.01, P = 0.93), metformin (HR 1.00, CI 0.99-1.01, P = 0.81), or sulfonylureas (HR 1.00, CI 0.99-1.02, P = 0.43) in the entire cohort, as well as when stratified into lower/higher-risk groups. On multivariable analysis in the lower-risk group, there was no association between DPP4i and OS (HR 0.98, CI 0.95-1.00, P = 0.06). Prospective studies with larger cohorts of patients and longer follow-up are required to further study the impact of DPP4i in MDS.
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Affiliation(s)
- Eugene Brailovski
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada.
| | - Qing Li
- ICES (Formerly Known As the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Ning Liu
- ICES (Formerly Known As the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Brian Leber
- Division of Hematology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - Dina Khalaf
- Division of Hematology, Juravinski Cancer Center, Hamilton, ON, Canada
| | | | - Grace Christou
- Division of Hematology, Ottawa Hospital, Ottawa, ON, Canada
| | - Karen Yee
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lisa Chodirker
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada
| | - Anne Parmentier
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada
| | - Mohammed Siddiqui
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada
| | - Alexandre Mamedov
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada
| | - Liying Zhang
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada
| | - Ying Liu
- ICES (Formerly Known As the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Craig C Earle
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada.,ICES (Formerly Known As the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada.,ICES (Formerly Known As the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pharmacology and Toxicology and Institute for Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rena J Buckstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada
| | - Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, T2M4N 3M5, Canada.,ICES (Formerly Known As the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
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Zadeh SL, Balassanian R, Cheung MC, Falchi L, Hasserjian R, Lin O, Long SR, Ly A, Menke JR, Mou E, Natkunam Y, Ruiz-Cordero R, Volaric AK, Wang L, Wen KW, Gratzinger D. Global Cytopathology-Hematopathology Practice Trends. Am J Clin Pathol 2022; 157:196-201. [PMID: 34508545 DOI: 10.1093/ajcp/aqab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Small-volume biopsy-fine-needle aspiration biopsy (FNAB) with or without core biopsy-is in increasing use in diagnosis and management of lymphoma patients. Our objective was to survey the current practice in small-volume biopsy diagnosis of lymphoma, focusing on the interaction among hematopathologists and cytopathologists and the integration of FNAB, core biopsy, and flow cytometry studies at sign-out. METHODS This study used a cross-sectional survey design employing the RedCap database distributed via nine pathology professional society email listservs. The survey consisted of 25 multiple-choice questions and several free text fields. In total, 128 pathologists participated. RESULTS Most respondents indicated that FNAB specimens in which lymphoma is a diagnostic consideration (FNAB-L) are seen daily or weekly (68/116; 58.6%). However, most institutions have separate hematopathology and cytopathology services (72/116; 62.1%) with inconsistent communication. When communication occurred, respondents were frequently inclined to reconsider their original diagnoses. Barriers identified included lack of communication, inadequate access to diagnostic studies, no formal subspecialty training, and various opinions regarding FNAB in diagnosing lymphoma. CONCLUSIONS This survey showed that FNAB-L specimens are common, with a lack of uniformity in how complementary fine-needle aspiration and core biopsy specimens or flow immunophenotyping results are shared across hematopathology and cytopathology services.
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Affiliation(s)
- Sara L Zadeh
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Ronald Balassanian
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Matthew C Cheung
- Department of Medicine, Division of Hematology/Oncology, University of Toronto, Toronto, Canada
| | - Lorenzo Falchi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven R Long
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Eric Mou
- College of Medicine, Division of Hematology, University of Iowa, Iowa City, IA, USA
| | | | - Roberto Ruiz-Cordero
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | - Linlin Wang
- Department of Laboratory Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University, Stanford, CA, USA
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Tilly H, Morschhauser F, Sehn LH, Friedberg JW, Trněný M, Sharman JP, Herbaux C, Burke JM, Matasar M, Rai S, Izutsu K, Mehta-Shah N, Oberic L, Chauchet A, Jurczak W, Song Y, Greil R, Mykhalska L, Bergua-Burgués JM, Cheung MC, Pinto A, Shin HJ, Hapgood G, Munhoz E, Abrisqueta P, Gau JP, Hirata J, Jiang Y, Yan M, Lee C, Flowers CR, Salles G. Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma. N Engl J Med 2022; 386:351-363. [PMID: 34904799 DOI: 10.1056/nejmoa2115304] [Citation(s) in RCA: 225] [Impact Index Per Article: 112.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is typically treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, only 60% of patients are cured with R-CHOP. Polatuzumab vedotin is an antibody-drug conjugate targeting CD79b, which is ubiquitously expressed on the surface of malignant B cells. METHODS We conducted a double-blind, placebo-controlled, international phase 3 trial to evaluate a modified regimen of R-CHOP (pola-R-CHP), in which vincristine was replaced with polatuzumab vedotin, as compared with standard R-CHOP, in patients with previously untreated intermediate-risk or high-risk DLBCL. Patients 18 to 80 years of age were randomly assigned in a 1:1 ratio to receive six cycles of either pola-R-CHP or R-CHOP, plus two cycles of rituximab alone. The primary end point was investigator-assessed progression-free survival. Secondary end points included overall survival and safety. RESULTS Overall, 879 patients underwent randomization: 440 were assigned to the pola-R-CHP group and 439 to the R-CHOP group. After a median follow-up of 28.2 months, the percentage of patients surviving without progression was significantly higher in the pola-R-CHP group than in the R-CHOP group (76.7% [95% confidence interval (CI), 72.7 to 80.8] vs. 70.2% [95% CI, 65.8 to 74.6] at 2 years; stratified hazard ratio for progression, relapse, or death, 0.73 by Cox regression; 95% CI, 0.57 to 0.95; P = 0.02). Overall survival at 2 years did not differ significantly between the groups (88.7% [95% CI, 85.7 to 91.6] in the pola-R-CHP group and 88.6% [95% CI, 85.6 to 91.6] in the R-CHOP group; hazard ratio for death, 0.94; 95% CI, 0.65 to 1.37; P = 0.75). The safety profile was similar in the two groups. CONCLUSIONS Among patients with previously untreated intermediate-risk or high-risk DLBCL, the risk of disease progression, relapse, or death was lower among those who received pola-R-CHP than among those who received R-CHOP. (Funded by F. Hoffmann-La Roche/Genentech; POLARIX ClinicalTrials.gov number, NCT03274492.).
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Affiliation(s)
- Hervé Tilly
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Franck Morschhauser
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Laurie H Sehn
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Jonathan W Friedberg
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Marek Trněný
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Jeff P Sharman
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Charles Herbaux
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - John M Burke
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Matthew Matasar
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Shinya Rai
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Koji Izutsu
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Neha Mehta-Shah
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Lucie Oberic
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Adrien Chauchet
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Wojciech Jurczak
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Yuqin Song
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Richard Greil
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Larysa Mykhalska
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Juan M Bergua-Burgués
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Matthew C Cheung
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Antonio Pinto
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Ho-Jin Shin
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Greg Hapgood
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Eduardo Munhoz
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Pau Abrisqueta
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Jyh-Pyng Gau
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Jamie Hirata
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Yanwen Jiang
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Mark Yan
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Calvin Lee
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Christopher R Flowers
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
| | - Gilles Salles
- From the Department of Hematology and INSERM Unité 1245, Centre Henri-Becquerel and University of Rouen, Rouen (H.T.), Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), CHU de Montpellier, Montpellier (C.H.), the Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse (L.O.), and the Department of Hematology, Centre Hospitalier Régional Universitaire - Besançon, Besançon (A.C.) - all in France; the Centre for Lymphoid Cancer at BC Cancer and the University of British Columbia, Vancouver (L.H.S.), the Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (M.C.C.), and F. Hoffmann-La Roche, Mississauga, ON (M.Y.) - all in Canada; the Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and Memorial Sloan Kettering Cancer Center, New York (M.M., G.S.) - both in New York; the First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic (M.T.); the Willamette Valley Cancer Institute and Research Center, the US Oncology Network, Eugene, OR (J.P.S.); Rocky Mountain Cancer Centers, Aurora, CO (J.M.B.); Memorial Sloan Kettering Cancer Center, Montvale, NJ (M.M.); the Department of Hematology and Rheumatology, Kindai University, Faculty of Medicine, Osaka-Sayama City (S.R.), and the National Cancer Center Hospital, Tokyo (K.I.) - both in Japan; Washington University in St. Louis, St. Louis (N.M.-S.); the Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland (W.J.); Peking University Cancer Hospital, Beijing (Y.S.); the 3rd Medical Department, Paracelsus Medical University, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, and Cancer Cluster Salzburg, Salzburg, Austria (R.G.); the Feofaniya Clinical Hospital, Kyiv, Ukraine (L.M.); Hospital San Pedro de Alcántara, Cáceres (J.M.B.-B.), and the Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona (P.A.) - both in Spain; the Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, Italy (A.P.); the Division of Hematology-Oncology, Department of Internal Medicine, Research Institute of Medical Science, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.S.); Princess Alexandra Hospital, Brisbane, QLD, Australia (G.H.); Hospital Erasto Gaertner, Curitiba, Brazil (E.M.); Taipei Veterans General Hospital, Taipei, Taiwan (J.-P.G.); Genentech, South San Francisco, CA (J.H., Y.J., C.L.); and M.D. Anderson Cancer Center, Houston (C.R.F.)
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Giannakeas V, Kotsopoulos J, Brooks JD, Cheung MC, Rosella L, Lipscombe L, Akbari MR, Austin PC, Narod SA. Platelet Count and Survival after Cancer. Cancers (Basel) 2022; 14:cancers14030549. [PMID: 35158817 PMCID: PMC8833779 DOI: 10.3390/cancers14030549] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Platelets are cellular fragments circulating in the blood that are responsible for clotting. Previous research has shown that cancer patients with an abnormally high platelet count (thrombocytosis) have elevated rates of death from cancer. We aimed to investigate to what extent platelet counts are associated with survival after cancer. We followed a large provincial cohort of cancer patients with a platelet count recorded at the time of their diagnosis. We categorized patients according to platelet count (low, medium, high). Cancer patients in the ‘high’ platelet count category had the highest rate of cancer death, and cancer patients in the ‘low’ platelet count category had the lowest rate of cancer death. Platelet count may be used to predict survival in cancer patients. Abstract Thrombocytosis is associated with cancer progression and death for many cancer types. It is unclear if platelet count is also associated with cancer survival. We conducted a cohort study of 112,231 adults in Ontario with a diagnosis of cancer between January 2007 and December 2016. We included patients who had a complete blood count (CBC) completed in the 30 days prior to their cancer diagnosis. Subjects were assigned to one of three categories according to platelet count: low (≤25th percentile), medium (>25 to <75th percentile), and high (≥75th percentile). Study subjects were followed from the date of their cancer diagnosis for cancer-specific death. Of the 112,231 eligible cancer patients in the cohort study, 40,329 (35.9%) died from their cancer in the follow-up period. Relative to those with a medium platelet count, the rate of cancer-specific death was higher among individuals with a high platelet count (HR 1.52; 95%CI 1.48–1.55) and was lower among individuals with a low platelet count (HR 0.91; 95%CI 0.88–0.93). A high platelet count was associated with poor survival for many cancer types. Platelet count could potentially be used as a risk stratification measure for cancer patients.
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Affiliation(s)
- Vasily Giannakeas
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada; (V.G.); (J.K.); (L.L.); (M.R.A.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (J.D.B.); (L.R.)
- ICES, Toronto, ON M4N 3M5, Canada; (M.C.C.); (P.C.A.)
| | - Joanne Kotsopoulos
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada; (V.G.); (J.K.); (L.L.); (M.R.A.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (J.D.B.); (L.R.)
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (J.D.B.); (L.R.)
| | - Matthew C. Cheung
- ICES, Toronto, ON M4N 3M5, Canada; (M.C.C.); (P.C.A.)
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (J.D.B.); (L.R.)
| | - Lorraine Lipscombe
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada; (V.G.); (J.K.); (L.L.); (M.R.A.)
- ICES, Toronto, ON M4N 3M5, Canada; (M.C.C.); (P.C.A.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Mohammad R. Akbari
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada; (V.G.); (J.K.); (L.L.); (M.R.A.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (J.D.B.); (L.R.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Peter C. Austin
- ICES, Toronto, ON M4N 3M5, Canada; (M.C.C.); (P.C.A.)
- Institute of Health Policy Management and Evaluation, University of Toronto Ontario Canada, Toronto, ON M5T 3M6, Canada
| | - Steven A. Narod
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada; (V.G.); (J.K.); (L.L.); (M.R.A.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (J.D.B.); (L.R.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence: ; Tel.: +1-416-351-3765; Fax: +1-416-351-3767
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Giannakeas V, Kotsopoulos J, Cheung MC, Rosella L, Brooks JD, Lipscombe L, Akbari MR, Austin PC, Narod SA. Analysis of Platelet Count and New Cancer Diagnosis Over a 10-Year Period. JAMA Netw Open 2022; 5:e2141633. [PMID: 35015064 PMCID: PMC8753503 DOI: 10.1001/jamanetworkopen.2021.41633] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Individuals with cancer often have an elevated platelet count at the time of diagnosis. The extent to which an elevated platelet count is an indicator of cancer is unclear. OBJECTIVE To evaluate the association of an elevated platelet count with a cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTS This nested case-control study included Ontario residents enrolled in the provincial health insurance plan who had 1 or more routine complete blood count (CBC) tests performed between January 1, 2007, and December 31, 2017, with follow-up through December 31, 2018. Case patients were individuals with a new cancer diagnosis during the observation period. Eligible control individuals were cancer free before the date of diagnosis for a case patient to whom they were matched. One case patient was matched to 3 controls based on sex, age, and health care use patterns. Data were analyzed from September 24, 2020, to July 13, 2021. EXPOSURES Case patients and controls were assigned to 1 of 5 exposure groups based on age- and sex-specific platelet count distributions in the control population: very low (≤10th percentile), low (>10th to 25th percentile), medium (>25th to <75th percentile), high (75th to <90th percentile), and very high (≥90th percentile). MAIN OUTCOMES AND MEASURES Odds ratios (ORs) were estimated for specific cancer sites for each category of platelet count at intervals up to 10 years after a blood test. RESULTS Of the 8 917 187 eligible Ontario residents with a routine CBC record available, 4 971 578 (55.8%) were women; the median age at the first CBC was 46.4 years (IQR, 32.5-59.5 years). Among individuals with a routine CBC record available, 495 341 (5.6%) received a diagnosis of first primary cancer during the 10-year observation period. The OR for a solid tumor diagnosis associated with a very high platelet count vs a medium platelet count in the 6-month period before the diagnosis was 2.32 (95% CI, 2.28-2.35). A very high platelet count was associated with colon (OR, 4.38; 95% CI, 4.22-4.54), lung (OR, 4.37; 95% CI, 4.22-4.53), ovarian (OR, 4.62; 95% CI, 4.19-5.09), and stomach (OR, 4.27; 95% CI, 3.91-4.66) cancers. Odds ratios attenuated with increasing time from CBC test to cancer diagnosis. CONCLUSIONS AND RELEVANCE In this nested case-control study, an elevated platelet count was associated with increased risk of cancer at several sites. Our findings suggest that an elevated platelet count could potentially serve as a marker for the presence of some cancer types.
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Affiliation(s)
- Vasily Giannakeas
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Joanne Kotsopoulos
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C. Cheung
- ICES, Toronto, Ontario, Canada
- Division of Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine Lipscombe
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Women’s College Hospital, Toronto, Ontario, Canada
| | - Mohammad R. Akbari
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Steven A. Narod
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Thomson S, Everest L, Witzke N, Jiao T, Delos Santos S, Nguyen V, Cheung MC, Chan KKW. Examining the association between oncology drug clinical benefit and the time to public reimbursement. Cancer Med 2021; 11:380-391. [PMID: 34850587 PMCID: PMC8729052 DOI: 10.1002/cam4.4455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background We examined if oncology drug indications with high clinical benefit, as measured by the American Society of Clinical Oncology Value Framework (ASCO‐VF) and European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO‐MCBS), received public reimbursement status faster than those with lower clinical benefit from the time of pan‐Canadian Oncology Drug Review (pCODR) recommendation. Methods Oncology drug indications submitted to pCODR between July 2011 and October 2018 were examined. Included indications had a regulatory approval date, completed the pCODR review process, received a positive pCODR recommendation, and been funded by at least one province. Trials cited for clinical efficacy were used to determine the clinical benefit (per ASCO‐VF and ESMO‐MCBS) of drug indications. Results Eighty‐four indications were identified, yielding 65 ASCO‐VF and 50 ESMO‐MCBS scores. The mean ASCO‐VF and ESMO‐MCBS scores were 44.9 (SD = 21.1) and 3.3 (SD = 1.0), respectively. The mean time to provincial reimbursement from pCODR recommendation was 13.2 months (SD = 9.3 months). Higher ASCO‐VF and ESMO‐MCBS scores had low correlation with shorter time to reimbursement, (ρ = −0.21) and (ρ = 0.24), respectively. In the multivariable analyses, ASCO‐VF (p = 0.40) and ESMO‐MCBS (p = 0.31) scores were not significantly associated with time to reimbursement. Province and year of pCODR recommendation were associated with time to reimbursement in both ASCO and ESMO models. Conclusions Oncology drug indications with higher clinical benefit do not appear to be reimbursed faster than those with low clinical benefit. This suggests the need to prioritize oncology drug indications based on clinical benefit to ensure quicker access to oncology drugs with the greatest benefits.
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Affiliation(s)
- Sasha Thomson
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Louis Everest
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Noah Witzke
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tina Jiao
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Seanthel Delos Santos
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Vivian Nguyen
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
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Vyas MV, Fang J, Austin PC, Laupacis A, Cheung MC, Silver FL, Kapral MK. Importance of accounting for loss to follow-up when comparing mortality between immigrants and long-term residents: a population-based retrospective cohort. BMJ Open 2021; 11:e046377. [PMID: 34728439 PMCID: PMC8565574 DOI: 10.1136/bmjopen-2020-046377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To evaluate the association between immigration status and all-cause mortality in different disease cohorts, and the impact of loss to follow-up on the observed associations. DESIGN Population-based retrospective cohort study using linked administrative health data in Ontario, Canada. SETTING We followed adults with a first-ever diagnosis of ischaemic stroke, cancer or schizophrenia between 2002 and 2013 from index event to death, loss to follow-up, or end of follow-up in 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Our outcomes of interest were all-cause mortality and loss to follow-up. For each disease cohort, we calculated adjusted HRs of death in immigrants compared with long-term residents, adjusting for demographic characteristics and comorbidities, with and without censoring for those who were lost to follow-up. We calculated the ratio of two the HRs and the respective CL using bootstrapping methods. RESULTS Immigrants were more likely to be lost to follow-up than long-term residents in all disease cohorts. Not accounting for this loss to follow-up overestimated the magnitude of the association between immigration status and mortality in those with ischaemic stroke (HR of death before vs after accounting for censoring: 0.78 vs 0.83, ratio=0.95; 95% CL 0.93 to 0.97), cancer (0.74 vs 0.78, ratio=0.96; 0.95 to 0.96), and schizophrenia (0.54 vs 0.56, ratio=0.97; 0.96 to 0.98). CONCLUSIONS Immigrants to Canada have a survival advantage that varies by the disease studied. The magnitude of this advantage is modestly overestimated by not accounting for the higher loss to follow-up in immigrants.
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Affiliation(s)
- Manav V Vyas
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | - Andreas Laupacis
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Division of Haematology & Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank L Silver
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Moira K Kapral
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Cheung MC, Mittmann N, Owen C, Abdel-Samad N, Fraser GAM, Lam S, Crump M, Sperlich C, van der Jagt R, Prica A, Couban S, Woyach JA, Ruppert AS, Booth AM, Mandrekar SJ, McDonald G, Shepherd LE, Yen H, Chen BE, Hay AE. A Prospective Economic Analysis of Early Outcome Data From the Alliance A041202/ CCTG CLC.2 Randomized Phase III Trial Of Bendamustine-Rituximab Compared With Ibrutinib-Based Regimens in Untreated Older Patients With Chronic Lymphocytic Leukemia. Clin Lymphoma Myeloma Leuk 2021; 21:766-774. [PMID: 34334330 PMCID: PMC8568662 DOI: 10.1016/j.clml.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The Alliance A041202/CCTG CLC.2 trial demonstrated superior progression-free survival with ibrutinib-based therapy compared to chemoimmunotherapy with bendamustine-rituximab (BR) in previously untreated older patients with chronic lymphocytic leukemia. We completed a prospective trial-based economic analysis of Canadian patients to study the direct medical costs and quality-adjusted benefit associated with these therapies. METHODS Mean survival was calculated using the restricted mean survival method from randomization to the study time-horizon of 24 months. Health state utilities were collected using the EuroQOL EQ-5D instrument with Canadian tariffs applied to calculate quality-adjusted life years (QALYs). Costs were applied to resource utilization data (expressed in 2019 US dollars). We examined costs and QALYs associated ibrutinib, ibrutinib with rituximab (IR), and BR therapy. RESULTS A total of 55 patients were enrolled; two patients were excluded from the analysis. On-protocol costs (associated with protocol-specified resource use) were higher for patients receiving ibrutinib (mean $189,335; P < 0.0001) and IR (mean $219,908; P < 0.0001) compared to BR (mean $51,345), driven by higher acquisition costs for ibrutinib. Total mean costs (over 2-years) were $192,615 with ibrutinib, $223,761 with IR, and $55,413 with BR (P < 0.0001 for ibrutinib vs. BR and P < 0.0001 for IR vs. BR). QALYs were similar between the three treatment arms: 1.66 (0.16) for ibrutinib alone, 1.65 (0.24) for IR, and 1.66 (0.17) for BR; therefore, a formal cost-utility analysis was not conducted. CONCLUSIONS Direct medical costs are higher for patients receiving ibrutinib-based therapies compared to chemoimmunotherapy in frontline chronic lymphocytic leukemia, with the cost of ibrutinib representing a key driver.
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Affiliation(s)
- Matthew C Cheung
- Division of Hematology, Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Canadian Cancer Trials Group, Queens University, Kingston, Canada.
| | - Nicole Mittmann
- Canadian Cancer Trials Group, Queens University, Kingston, Canada; Department of Pharmacology and Toxicology and Institute for Health Policy Management and Evaluation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Carolyn Owen
- Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Canada
| | | | - Graeme A M Fraser
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Selay Lam
- Victoria Hospital, Western University, London, Canada
| | - Michael Crump
- Canadian Cancer Trials Group, Queens University, Kingston, Canada; Division of Hematology, Department of Medicine, Princess Margaret Hospital and University of Toronto, Toronto, Canada
| | - Catherine Sperlich
- Centre integre de Santé et de Services Sociaux de la Montérégie-Centre, Greenfield Park, Canada
| | | | - Anca Prica
- Canadian Cancer Trials Group, Queens University, Kingston, Canada; Division of Hematology, Department of Medicine, Princess Margaret Hospital and University of Toronto, Toronto, Canada
| | - Stephen Couban
- Canadian Cancer Trials Group, Queens University, Kingston, Canada; Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada
| | | | - Amy S Ruppert
- Division of Hematology, The Ohio State University, Columbus, OH; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Allison M Booth
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, and Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Sumithra J Mandrekar
- Department of Quantitative Health Sciences, and Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Gail McDonald
- Canadian Cancer Trials Group, Queens University, Kingston, Canada
| | - Lois E Shepherd
- Department of Pharmacology and Toxicology and Institute for Health Policy Management and Evaluation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Hope Yen
- Canadian Cancer Trials Group, Queens University, Kingston, Canada
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queens University, Kingston, Canada
| | - Annette E Hay
- Canadian Cancer Trials Group, Queens University, Kingston, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada
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34
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Zadeh SL, Balassanian R, Cheung MC, Falchi L, Hasserjian R, Lin O, Long SR, Ly A, Menke JR, Mou E, Natkunam Y, Ruiz-Cordero R, Volaric AK, Wang L, Wen KW, Gratzinger D. Corrigendum to: Global Cytopathology-Hematopathology Practice Trends. Am J Clin Pathol 2021; 157:155. [PMID: 34595513 PMCID: PMC9890207 DOI: 10.1093/ajcp/aqab184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Ronald Balassanian
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Matthew C Cheung
- Department of Medicine, Division of Hematology/Oncology, University of Toronto, Toronto, Canada
| | - Lorenzo Falchi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven R Long
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Eric Mou
- College of Medicine, Division of Hematology, University of Iowa, Iowa City, IA, USA
| | | | - Roberto Ruiz-Cordero
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | - Linlin Wang
- Department of Laboratory Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University, Stanford, CA, USA
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35
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Ferreyro BL, Scales DC, Wunsch H, Cheung MC, Gupta V, Saskin R, Thyagu S, Munshi L. Critical illness in patients with hematologic malignancy: a population-based cohort study. Intensive Care Med 2021; 47:1104-1114. [PMID: 34519845 DOI: 10.1007/s00134-021-06502-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/02/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the modern incidence and predictors of ICU admission for adult patients newly diagnosed with a hematologic malignancy. METHODS We conducted a population-based cohort study of adults with a new diagnosis of hematologic malignancy (April 1, 2006-March 31, 2017) in Ontario, Canada. We described the baseline demographic, clinical and laboratory predictors of ICU admission and subsequent mortality. The primary outcome was the incidence of ICU admission within 1 year of hematologic malignancy diagnosis. We assessed the predictors of ICU admission using Cox-proportional models that accounted for the competing risk of death and reported as subdistribution hazard ratios (sHR) with 95% confidence intervals (CI). RESULTS A total of 87,965 patients (mean [SD] age, 67.8 (15.7) years) were included. The 1-year incidence of ICU admission was 13.9% (median time 35 days), ranging from 7.3% (indolent lymphoma) to 22.5% (acute myeloid leukemia). After multivariable adjustment, compared to indolent lymphoma, acute myeloid leukemia (sHR, 3.09; 95% CI 2.84-3.35), aggressive non-Hodgkin lymphoma (sHR, 2.47; 95% CI 2.31-2.65) and acute lymphoblastic leukemia (sHR, 2.46; 95% CI 2.15-2.80) had the highest risk of ICU admission. Comorbidities such as cardiovascular disease (sHR, 2.09; 95% CI 2.01-2.19), chronic obstructive pulmonary disease (sHR, 1.33; 95% CI 1.26-1.39) and baseline laboratory abnormalities (anemia, thrombocytopenia and high creatinine) were also associated with ICU admission. Among ICU patients, 36.7% required invasive mechanical ventilation and in-hospital mortality was 31%. CONCLUSION Critical illness in patients with a newly diagnosed hematologic malignancy is frequent, occurring early after diagnosis. Certain baseline characteristics can help identify those patients at the highest risk.
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Affiliation(s)
- Bruno L Ferreyro
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada. .,Mount Sinai Hospital, 600 University Avenue, 18-210, Toronto, ON, M5G 1X5, Canada.
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,ICES, Toronto, ON, Canada.,Applied Health Research Center (AHRC), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Hannah Wunsch
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,ICES, Toronto, ON, Canada
| | - Matthew C Cheung
- ICES, Toronto, ON, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Vikas Gupta
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - Santhosh Thyagu
- Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada
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36
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Silverstein WK, Lin Y, Dharma C, Croxford R, Cheung MC. Physician Factors Associated with Inappropriate Vitamin B12 Prescribing in Ontario, Canada. J Gen Intern Med 2021; 36:2888-2890. [PMID: 32909232 PMCID: PMC8390716 DOI: 10.1007/s11606-020-06185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- William K Silverstein
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Yulia Lin
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | | | - Matthew C Cheung
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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37
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Smyth L, Blunt DN, Cheung MC. Statins in mature B-cell lymphomas and leukaemias. Br J Haematol 2021; 195:490-492. [PMID: 34402051 DOI: 10.1111/bjh.17778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Liam Smyth
- Department of Haematology, St Vincent's University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Danielle N Blunt
- Department of Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Matthew C Cheung
- Odette Cancer Centre, Sunnybroook Health Sciences Centre, Toronto, ON, Canada.,Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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38
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Mou E, Falchi L, Sundaram V, Abramson JS, Balassanian R, Beygi S, Fitzpatrick MJ, Frank AK, Gupta S, Lin O, Long SR, Menke JR, Reed DR, Ruiz-Cordero R, Volaric AK, Xie Y, Wang L, Wen KW, Zadeh SL, Natkunam Y, Cheung MC, Gratzinger D. Impact of initial biopsy type on the time to final diagnostic biopsy in patients with follicular lymphoma and suspected histologic transformation. Leuk Lymphoma 2021; 62:2864-2872. [PMID: 34176413 DOI: 10.1080/10428194.2021.1941936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diagnosis of histologic transformation (HT) of follicular lymphoma (FL) requires tissue biopsy. While surgical biopsy represents the gold standard, less invasive procedures such as fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) are frequently performed. In this retrospective multi-institutional study including 269 patients with FL and suspected HT, the median time from initial clinical suspicion to final diagnostic biopsy was similar whether the workup began with FNAB, CNB, or surgical biopsy (4, 9, and 6 days, respectively; p=.27), despite more subsequent biopsies performed following initial FNAB. Periprocedural complications were uniformly minimal. Biopsy-proven HT was more common in the initial surgery group and in workups including positron emission tomography/computed tomography (PET/CT). Our findings, derived from US academic centers with specialized procedural and pathology expertise, suggest that FNAB, CNB, and surgical biopsy are all viable initial diagnostic procedures that can inform clinical decision-making in select FL patients with suspected HT.
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Affiliation(s)
- Eric Mou
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA, USA.,Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lorenzo Falchi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vandana Sundaram
- Quantitative Science Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Sara Beygi
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Annabel Kate Frank
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Srishti Gupta
- Department of Pathology, University of Virginia, Charlottesville, VA, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Steven R Long
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,Department of Pathology, Stanford University, Stanford, CA, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Daniel R Reed
- Section of Hematology and Oncology, Wake Forest Baptist Medical Comprehensive Cancer Center.,Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Ashley K Volaric
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Yi Xie
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Linlin Wang
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sara L Zadeh
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | | | - Matthew C Cheung
- Division of Hematology, Sunnybrook Odette Cancer Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Dita Gratzinger
- Department of Pathology, Stanford University, Stanford, CA, USA.,Department of Pathology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Monteith BE, Venner CP, Cheung MC, Pater J, Shepherd L, Richardson H, Reece D, Gul E, Lalancette M, Castonguay V, Kukreti V, Tiedemann R, Phua C, Bhella S, Dudebout J, Sherry M, Yen H, Chen BE, Hay AE. A descriptive cost-analysis of MYX.1/MCRN003, a phase 2 clinical trial evaluating high-dose weekly carfilzomib, cyclophosphamide, and dexamethasone in relapsed and refractory multiple myeloma. Eur J Haematol 2021; 107:333-342. [PMID: 34053112 DOI: 10.1111/ejh.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalence of multiple myeloma is increasing and there is a need to evaluate escalating therapy costs (Canadian Cancer Statistics A, 2020). The MYX.1 phase II trial showed that high-dose weekly carfilzomib, cyclophosphamide, and dexamethasone (wKCD) is efficacious in relapsed and refractory disease. We conducted a descriptive cost analysis, from the perspective of the Canadian public healthcare system, using trial data. METHODS The primary outcome was the mean total cost per patient. Resource utilization data were collected from all 75 trial patients over a trial time horizon. Costs are presented in Canadian dollars (2020). RESULTS The cost of treatment was calculated from the time of patient (pt) enrollment until the second data lock. The mean total cost was $203 336.08/pt (range $17 891.27-$505 583.55) Canadian dollars (CAD, where 1 CAD = 0.67 Euro (EUR)) and $14 081.45/pt per cycle. The median number of cycles was 15. The predominant cost driver was the cost of chemotherapy accounting for an average of $179 332.78/pt or $12 419.17/pt per cycle. Carfilzomib acquisition accounted for the majority of chemotherapy costs - $162 471.65/pt or $11 251.50/pt per cycle. Fifty-six percent (56%) of patients had at least one hospitalization during the trial period with an average cost of $12 657.86 per hospitalization. Three patients developed thrombotic microangiopathy (TMA) with an average cost of $18 863.32/pt including the cost of hospitalizations and therapeutic plasma exchange. CONCLUSIONS High-dose wKCD is an active triplet regimen for relapsed and refractory multiple myeloma (RRMM) associated with reduced total cost compared with twice-weekly carfilzomib-based regimens.
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Affiliation(s)
- Bethany E Monteith
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada.,Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | | | - Matthew C Cheung
- Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Joe Pater
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | | | - Donna Reece
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Engin Gul
- Canadian Myeloma Research Group (formerly the Myeloma Canada Research Network), Vaughan, ON, Canada
| | - Marc Lalancette
- CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Quebec City, QC, Canada
| | - Vincent Castonguay
- CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Quebec City, QC, Canada
| | - Vishal Kukreti
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Rodger Tiedemann
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Chai Phua
- Victoria Hospital, Western University, London, ON, Canada
| | - Sita Bhella
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Jill Dudebout
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Max Sherry
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Hope Yen
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Annette E Hay
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada.,Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
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Ahluwalia M, Parmar A, Chen EX, Jonker DJ, Loree JM, O'Callaghan CJ, Mittmann N, Cheung MC, Feilotter H, Monzon JG, Ng DM, Elfiki TA, Hammad N, Lemay F, Tremblay A, Hubay S, Lenehan JG, Salim M, Tu D, Chan KK. A cost-utility analysis of combined durvalumab and tremelimumab in patients with refractory metastatic colorectal cancer (mCRC) and high plasma tumour mutation burden (pTMB): A Canadian Cancer Trials Group (CCTG) study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e15581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15581 Background: The randomized phase II CCTG CO.26 clinical trial investigated the use of combined durvalumab and tremelimumab vs. best supportive care (BSC) for patients with mCRC and suggested an increase in overall survival (OS). The largest benefit was seen in patients who were microsatellite stable (MSS) with a pTMB ≥ 28 variants per megabase. Considering significantly higher adverse event rates and costs associated with durvalumab and tremelimumab, it is important to evaluate its cost-effectiveness. Accordingly, we performed a cost-utility analysis of durvalumab and tremelimumab compared to BSC in the intention-to-treat (ITT) and biomarker-enriched populations using CO.26 trial data. Methods: We developed a 4-state microsimulation model to evaluate the expected health outcomes in life-years (LYs), quality-adjusted life-years (QALYs) and costs of the treatment group compared to BSC over a lifetime horizon (5 years). The incremental cost-utility ratio (ICUR) was used to compare treatment strategies. Direct trial data from CO.26 were used to inform model inputs, including OS curves, progression-free survival (PFS) curves, and adverse event rates. As health state utilities were not collected in CO.26, values from the CORRECT trial, a multi-centre randomized placebo-controlled phase III study for regorafenib in mCRC, were used. Costs of therapy, hospitalization due to adverse events, end-of-life care, and physician costs were derived from the literature and publicly available sources (in 2020 Canadian dollars). Since the monthly price of tremelimumab was unavailable, it was approximated with the price of another CTLA-4 inhibitor, ipilimumab. The base-case analysis evaluated these treatment strategies in the ITT population. Scenario analyses evaluated the cost-effectiveness in biomarker-enriched populations. Costs and effects were discounted at 1.5% as per Canadian guidelines. Results: In the base-case, expected LYs for combined durvalumab and tremelimumab and BSC were 0.75 and 0.51 (incremental (Δ) 0.24) respectively. Expected QALYs were 0.47 and 0.33 (Δ 0.14). Expected lifetime costs were $60 500 and $15 500 (Δ $45 000) for an ICUR of $320 000/QALY. In the biomarker-enriched subgroup, the expected LYs were 0.67 and 0.33 (Δ 0.34), expected QALYs were 0.43 and 0.22 (Δ 0.21), and expected lifetime costs were $62 000 and $15 200 (Δ $47 000). This represents an increase in the incremental QALYs by 50% and costs by 5% for an ICUR 30% lower than the base case at $220 000/QALY. Conclusions: Combined durvalumab and tremelimumab is not considered cost-effective in refractory mCRC under conventional willingness-to-pay thresholds. Cost-effectiveness is improved with biomarker enrichment for high pTMB, driven by the greater derived health outcomes in this subgroup.
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Affiliation(s)
| | - Ambika Parmar
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Nicole Mittmann
- Canadian Agency for Drugs and Technologies in Health, Toronto, ON, Canada
| | - Matthew C. Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Harriet Feilotter
- Queen's University, Department of Pathology and Molecular Medicine, Kingston, ON, Canada
| | | | - Dawn Marie Ng
- Simcoe Muskoka Reg Cancer Prog, Woodbridge, ON, Canada
| | | | - Nazik Hammad
- Department of Oncology, Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Frederic Lemay
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | | | - Stacey Hubay
- Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | | | | | - Dongsheng Tu
- Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada
| | - Kelvin K. Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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Thomson S, Witzke N, Gyawali B, Delos Santos S, Udayakumar S, Cardone C, Cheung MC, Chan KKW. Assessing the benefit of cancer drugs approved by the European Medicines Agency using the European Society for Medical Oncology Magnitude of Clinical Benefit Scale over time. Eur J Cancer 2021; 150:203-210. [PMID: 33932727 DOI: 10.1016/j.ejca.2021.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increasingly, cancer drugs are being approved based on surrogate measurements of efficacy. Clinically meaningful data, such as overall survival (OS) and quality of life, are often only presented in subsequent publications. We examined if the clinical benefit of cancer drugs, as measured by the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS), improves post-European Medicines Agency (EMA) approval as more data emerges. METHODS Cancer drug indications approved by the EMA from January 2006 to December 2016 were reviewed and trials cited for efficacy were identified. Primary and subsequent publications (up to December 2019) of scorable trials were included. Changes in benefit over time were measured using ESMO-MCBS thresholds for non-curative (≥4 for substantial, =3 for intermediate and ≤2 for low benefit) and curative intent (A or B for major benefit) scoring. RESULTS Fifty-five non-curative and two curative intent trials were included. At approval, 29.1% of non-curative trials were substantial, 45.5% intermediate and 25.5% low benefit. For curative intent trials, one displayed major benefit and one displayed no major benefit. We identified 82 subsequent publications for reassessment. A change in ESMO-MCBS classification was seen in 34.5% of non-curative trials (11 raised and 8 lowered). At 3-year reassessment, 36.4% of non-curative trials were substantial, 34.5% intermediate and 29.1% low benefit. Both curative trials showed no major benefit at reassessment. CONCLUSION As over a third of trials changed classification, in either direction, reassessing the ESMO-MCBS score of approved cancer drugs may help to inform patients and ensure ongoing relevance of regulatory and reimbursement decisions.
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Affiliation(s)
- Sasha Thomson
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Noah Witzke
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bishal Gyawali
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Seanthel Delos Santos
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Suji Udayakumar
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Claudia Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Matthew C Cheung
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
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Cheung MC, Chan KK, Golden S, Hay A, Pater J, Prica A, Chen BE, Leighl N, Mittmann N. Minimization of resource utilization data collected within cost-effectiveness analyses conducted alongside Canadian Cancer Trials Group phase III trials. Clin Trials 2021; 18:500-504. [PMID: 33866856 PMCID: PMC8290988 DOI: 10.1177/17407745211005045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Cost-effectiveness analyses embedded within randomized trials allow for evaluation of value alongside conventional efficacy outcomes; however, collection of resource utilization data can require considerable trial resources. Methods We re-analyzed the results from four phase III Canadian Cancer Trials Group trials that embedded cost-effectiveness analyses to determine the impact of minimizing potential cost categories on the incremental cost-effectiveness ratios. For each trial, we disaggregated total costs into component incremental cost categories and recalculated incremental cost-effectiveness ratios using (1) only the top 3 cost categories, (2) the top 5 cost categories, and (3) all cost components. Using individual trial-level data, confidence intervals for each incremental cost-effectiveness ratio simulation were generated by bootstrapping and descriptively presented with the original confidence intervals (and incremental cost-effectiveness ratios) from the publications. Results Drug acquisition costs represented the highest incremental cost category in three trials, while hospitalization costs represented the other consistent cost driver and the top incremental cost category in the fourth trial. Recalculated incremental cost-effectiveness ratios based on fewer cost components (top 3 and top 5) did not differ meaningfully from the original published results. Based on conventional willingness-to-pay thresholds (US$50,000–US$100,000 per quality-adjusted life-year), none of the re-analyses would have changed the original perception of whether the experimental therapies were considered cost-effective. Conclusions These results suggest that the collection of resource utilization data within cancer trials could be narrowed. Omission of certain cost categories that have minimal impact on incremental cost-effectiveness ratio, such as routine laboratory investigations, could reduce the costs and undue burden associated with the collection of data required for cancer trial cost-effectiveness analyses.
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Affiliation(s)
- Matthew C Cheung
- Division of Hematology, Department of Medicine, Odette Cancer Centre and University of Toronto, Toronto, ON, Canada.,Committee on Economic Analysis, Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kelvin Kw Chan
- Division of Hematology, Department of Medicine, Odette Cancer Centre and University of Toronto, Toronto, ON, Canada.,Committee on Economic Analysis, Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
| | - Shane Golden
- Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
| | - Annette Hay
- Committee on Economic Analysis, Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
| | - Joseph Pater
- Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
| | - Anca Prica
- Division of Hematology, Department of Medicine, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
| | - Natasha Leighl
- Division of Hematology, Department of Medicine, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - Nicole Mittmann
- Committee on Economic Analysis, Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
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Rodin D, Glicksman RM, Clark K, Kakani P, Cheung MC, Singh S, Rosenthal M, Sinaiko AD. Mammographic Surveillance in Older Women With Breast Cancer in Canada and the United States: Are We Choosing Wisely? Pract Radiat Oncol 2021; 11:e384-e394. [PMID: 33753302 DOI: 10.1016/j.prro.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Guidelines on mammographic surveillance after breast cancer treatment have been disseminated internationally and incorporated into Choosing Wisely recommendations to reduce low-value care. However, adherence within different countries before their publication is unknown. METHODS AND MATERIALS Low-value mammography, defined as "short-interval" (within 6 months of radiation) or "high-frequency" (>1 within 12 months of radiation), was compared in Medicare fee-for-service in the United States and Ontario, Canada. Women ≥65 years diagnosed with breast cancer who underwent breast-conserving therapy with a minimum of 24 months of follow-up were included (n = 19,715 United States; 6479 Ontario). Secondary outcomes were patient and physician characteristics associated with discordance. RESULTS Short-interval mammography was higher in the United States than in Ontario (55.9% vs 38.0%, P < .001), as was high-frequency (39.6% vs 7.9%, P < .001). In Ontario, younger age (42% ≥85 vs 58% <74 years, P < .001) and chemotherapy (69% vs 51%, P < .001) were associated with short-interval mammography; in the United States, age, earlier diagnosis year, stage, chemotherapy, rurality, and academic center treatment were associated with greater use. Chemotherapy was associated with high-frequency mammography in both countries (13% vs 7% in Ontario, P < .001; 69% vs 51% in United States, P = .02); younger age, earlier diagnosis year, stage, and nonacademic center treatment were associated in the United States. In both countries, radiation oncologists had the highest proportion of providers ordering low-value mammograms. CONCLUSIONS Despite significant evidence guiding surveillance mammography recommendations, there are high rates of short-interval mammography in both the United States and Ontario, and high rates of high-frequency mammography in the United States. Further international efforts, such as Choosing Wisely, are needed to reduce low-value mammography.
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Affiliation(s)
- Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Rachel M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Clark
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Pragya Kakani
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anna D Sinaiko
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Prica A, Hay AE, Crump M, Mittmann N, Shepherd LE, Meyer RM, Imrie KI, Risebrough N, Djurfeldt M, Chen BE, Cheung MC. Evaluating the Indirect Costs of Care Associated with Salvage Chemotherapy for Relapsed and Refractory Aggressive-Histology Lymphoma: A Subset Analysis of the Canadian Cancer Trials Group (CCTG) LY.12 Clinical Trial. ACTA ACUST UNITED AC 2021; 28:1256-1261. [PMID: 33802634 PMCID: PMC8025821 DOI: 10.3390/curroncol28020119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/10/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
We conducted an analysis of indirect costs alongside the LY.12 randomized trial in patients with relapsed or refractory (R/R) aggressive non-Hodgkin lymphoma (NHL). Lost productivity data for Canadian patients and caregivers in the trial were collected at baseline and with each chemotherapy cycle pre-transplant, using an adapted Lost Productivity questionnaire. Mean per patient indirect costs were CAD 2999 for patients in the GDP arm and CAD 3400 in the DHAP arm. A substantial majority was not working or had to reduce their workload during this treatment time. Salvage chemotherapy for R/R aggressive NHL is associated with significant indirect costs to patients and their caregivers.
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Blunt DN, Smyth L, Nagamuthu C, Gatov E, Croxford R, Mozessohn L, Cheung MC. Shorter Diagnosis-to-Treatment Interval in Diffuse Large B-Cell Lymphoma is Associated With Inferior Overall Survival in a Large, Population-Based Registry. J Natl Compr Canc Netw 2021; 19:719-725. [PMID: 33691276 DOI: 10.6004/jnccn.2020.7654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Because of prolonged screening requirements, patient and time-dependent selection have been proposed as potential biases in clinical trials. The screening process may exclude patients with a need for emergent treatment (and a short period from diagnosis to treatment initiation [DTI]). We explored the impact of DTI on overall survival (OS) in a population-based cohort of patients with diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS Using population-based administrative databases in Ontario, Canada, we identified adults aged ≥18 years with DLBCL treated with rituximab-based chemotherapy for curative intent between January 2005 and December 2015. Cox regression and multivariable analyses were presented to evaluate the impact of time from DTI on OS, controlling for relevant covariates. RESULTS We identified 9,441 patients with DLBCL in Ontario; median age was 66 years, 53.6% were male, median number of comorbidities (Johns Hopkins aggregated diagnosis groups) was 10 (interquartile range [IQR], 8-13), and median DTI was 37 days (IQR, 22-61). Between treatment initiation and study end, 43% of patients died (median OS, 1 year; IQR, 0.4-2.8 years). Shorter DTI was a significant predictor of mortality (P<.001). Compared with the shortest DTI period of 0-18 days, those who commenced therapy at 19-29 days (hazard ratio [HR], 0.75; 95% CI, 0.68-0.84), 30-41 days (HR, 0.70; 95% CI, 0.63-0.78), 42-57 days (HR, 0.52; 95% CI, 0.46-0.58), and 58-180 days (HR, 0.52; 95% CI, 0.47-0.58) had improved survival. Increasing age (HR, 1.03; 95% CI, 1.03-1.04), male sex (HR, 1.23; 95% CI, 1.14-1.32), and increasing number of comorbidities (HR, 1.12; 95% CI, 1.11-1.13) were associated with inferior survival. CONCLUSIONS Among patients with DLBCL, shorter DTI was associated with inferior OS. Therefore, DTI may represent a surrogate marker for aggressive biology. Clinical trials with lengthy screening periods are likely creating a time-dependent patient selection bias.
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Affiliation(s)
- Danielle N Blunt
- 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,2Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Liam Smyth
- 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,3Department of Haematology, St. Vincent's University Hospital, Dublin, Ireland; and
| | | | | | | | - Lee Mozessohn
- 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew C Cheung
- 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,4ICES, and.,5Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hay AE, Mittmann N, Crump M, Cheung MC, Sleeth J, Needham J, Broekhoven M, Djurfeldt M, Shepherd LE, Meyer RM, Chen BE, Pater JL. A Canadian Prospective Study of Linkage of Randomized Clinical Trial to Cancer and Mortality Registry Data. ACTA ACUST UNITED AC 2021; 28:1153-1160. [PMID: 33800281 PMCID: PMC8025743 DOI: 10.3390/curroncol28020111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/20/2021] [Accepted: 03/03/2021] [Indexed: 01/11/2023]
Abstract
In a prospective study, we sought to determine acceptability of linkage of administrative and clinical trial data among Canadian patients and Research Ethics Boards (REBs). The goal is to develop a more harmonized approach to data, with potential to improve clinical trial conduct through enhanced data quality collected at reduced cost and inconvenience for patients. On completion of the original LY.12 randomized clinical trial in lymphoma (NCT00078949), participants were invited to enrol in the Long-term Innovative Follow-up Extension (LIFE) component. Those consenting to do so provided comprehensive identifying information to facilitate linkage with their administrative data. We prospectively designed a global assessment of this innovative approach to clinical trial follow-up including rates of REB approval and patient consent. The pre-specified benchmark for patient acceptability was 80%. Of 16 REBs who reviewed the research protocol, 14 (89%) provided approval; two in Quebec declined due to small patient numbers. Of 140 patients invited to participate, 115 (82%, 95% CI 76 to 88%) from across 9 Canadian provinces provided consent and their full name, date of birth, health insurance number and postal code to facilitate linkage with their administrative data for long-term follow-up. Linkage of clinical trial and administrative data is feasible and acceptable. Further collaborative work including many stakeholders is required to develop an optimized secure approach to research. A more coordinated national approach to health data could facilitate more rapid testing and identification of new effective treatments across multiple jurisdictions and diseases from diabetes to COVID-19.
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Affiliation(s)
- Annette E Hay
- Department of Medicine, Queen’s University, Kingston, ON K7L 2V6, Canada
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
- Correspondence:
| | - Nicole Mittmann
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada; (N.M.); (M.CC.)
| | - Michael Crump
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada;
| | - Matthew C Cheung
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada; (N.M.); (M.CC.)
| | - Jessica Sleeth
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Judy Needham
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Mike Broekhoven
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Marina Djurfeldt
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Lois E Shepherd
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Ralph M Meyer
- Juravinski Cancer Centre/Hamilton Health Sciences, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
| | - Joseph L Pater
- Canadian Cancer Trials Group, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.S.); (J.N.); (M.B.); (M.D.); (L.ES.); (B.EC.); (J.LP.)
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Abstract
BACKGROUND This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI). METHODS General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency. RESULTS Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures. CONCLUSIONS Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.
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Affiliation(s)
- M C Cheung
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - M S Hopcraft
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - I B Darby
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
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48
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Gong IY, Cheung MC, Read S, Na Y, Lega IC, Lipscombe LL. Association between diabetes and haematological malignancies: a population-based study. Diabetologia 2021; 64:540-551. [PMID: 33409570 DOI: 10.1007/s00125-020-05338-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/16/2020] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS Contemporary data for the association of diabetes with haematological malignancies are lacking. We evaluated the risk of developing haematological malignancies and subsequent mortality in individuals with diabetes compared with those without diabetes. METHODS We conducted a population-based observational study using healthcare databases from Ontario, Canada. All Ontario residents 30 years of age or older free of cancer and diabetes between 1 January 1996 and 31 December 2015 were eligible for inclusion. Using Cox regression analyses, we explored the association between diabetes and the risk and mortality of haematological malignancies (leukaemia, lymphoma, multiple myeloma). The impact of timing on associations was evaluated with analyses stratified by time since diabetes diagnosis (<3 months, 3 months to 1 year, ≥1 year). RESULTS We identified 1,003,276 individuals with diabetes and age and sex matched these to 2,006,552 individuals without diabetes. Compared with individuals without diabetes, those with diabetes had a modest but significantly higher risk of a haematological malignancy (adjusted HR 1.10 [95% CI 1.08, 1.12] p < 0.0001). This association persisted across all time periods since diabetes diagnosis. Among those with haematological malignancies, diabetes was associated with a higher all-cause mortality (HR 1.36 [95% CI 1.31, 1.41] p < 0.0001) compared with no diabetes, as well as cause-specific mortality. CONCLUSIONS/INTERPRETATION Diabetes is associated with a higher risk of haematological malignancies and is an independent risk factor of all-cause and cause-specific mortality. Greater efforts for lifestyle modification may not only reduce diabetes burden and its complications but may also potentially lower risk of malignancy and mortality. Graphical abstract.
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Affiliation(s)
- Inna Y Gong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, Ontario, Canada
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Stephanie Read
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Yingbo Na
- ICES, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Iliana C Lega
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Lorraine L Lipscombe
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- ICES, Toronto, Ontario, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
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49
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Kroft SH, Sever CE, Bagg A, Billman B, Diefenbach C, Dorfman DM, Finn WG, Gratzinger DA, Gregg PA, Leonard JP, Smith S, Souter L, Weiss RL, Ventura CB, Cheung MC. Laboratory Workup of Lymphoma in Adults: Guideline From the American Society for Clinical Pathology and the College of American Pathologists. Arch Pathol Lab Med 2021; 145:269-290. [PMID: 33175094 DOI: 10.5858/arpa.2020-0261-sa] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The diagnostic workup of lymphoma continues to evolve rapidly as experience and discovery led to the addition of new clinicopathologic entities and techniques to differentiate them. The optimal clinically effective, efficient, and cost-effective approach to diagnosis that is safe for patients can be elusive, in both community-based and academic practice. Studies suggest that there is variation in practice in both settings. OBJECTIVE.— To develop an evidence-based guideline for the preanalytic phase of testing, focusing on specimen requirements for the diagnostic evaluation of lymphoma. DESIGN.— The American Society for Clinical Pathology, the College of American Pathologists, and the American Society of Hematology convened a panel of experts in the laboratory workup of lymphoma to develop evidence-based recommendations. The panel conducted a systematic review of literature to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, recommendations were derived based on the available evidence, strength of that evidence, and key judgements as defined in the Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision framework. RESULTS.— Thirteen guideline statements were established to optimize specimen selection, ancillary diagnostic testing, and appropriate follow-up for safe and accurate diagnosis of indolent and aggressive lymphoma. CONCLUSIONS.— Primary diagnosis and classification of lymphoma can be achieved with a variety of specimens. Application of the recommendations can guide decisions on specimen suitability, diagnostic capabilities, and correct use of ancillary testing. Disease prevalence in patient populations, availability of ancillary testing, and diagnostic goals should be incorporated into algorithms tailored to each practice environment.
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Affiliation(s)
- Steven H Kroft
- From the Department of Pathology, Froedtert Hospital and the Medical Colleges of Wisconsin, Milwaukee (Kroft)
| | - Cordelia E Sever
- Pathology Associates of Albuquerque, Albuquerque, New Mexico (Sever)
| | - Adam Bagg
- The Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Bagg)
| | - Brooke Billman
- Governance Services (Billman), College of American Pathologists, Northfield, Illinois
| | - Catherine Diefenbach
- The Department of Medicine, New York University School of Medicine, New York, New York (Diefenbach)
| | - David M Dorfman
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dorfman)
| | - William G Finn
- The Department of Pathology and Laboratory Medicine, Warde Medical Laboratory, Ann Arbor, Michigan (Finn)
| | - Dita A Gratzinger
- The Department of Pathology, Stanford Health Care, Stanford, California (Gratzinger)
| | - Patricia A Gregg
- The Department of Pathology, Lehigh Regional Medical Center, Lehigh Acres, Florida (Gregg)
| | - John P Leonard
- The Department of Hematology and Oncology, Weill Cornell Medical College, New York, New York (Leonard)
| | - Sonali Smith
- The Department of Medicine, University of Chicago Medicine, Chicago, Illinois (Smith)
| | - Lesley Souter
- Souter is in private practice in Wellandport, Ontario, Canada
| | - Ronald L Weiss
- The Department of Pathology, ARUP Laboratories Inc, Salt Lake City, Utah (Weiss)
| | - Christina B Ventura
- The Pathology and Laboratory Quality Center (Ventura), College of American Pathologists, Northfield, Illinois
| | - Matthew C Cheung
- The Department of Medicine, Odette Cancer Centre/Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Cheung)
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50
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Delos Santos S, Witzke N, Gyawali B, Arciero VS, Rahmadian AP, Everest L, Cheung MC, Chan KK. Reassessing the Net Benefit of Cancer Drugs With Evolution of Evidence Using the ASCO Value Framework. J Natl Compr Canc Netw 2021; 19:815-820. [PMID: 33636693 DOI: 10.6004/jnccn.2020.7677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Regulatory approval of oncology drugs is often based on interim data or surrogate endpoints. However, clinically relevant data, such as long-term overall survival and quality of life (QoL), are often reported in subsequent publications. This study evaluated the ASCO-Value Framework (ASCO-VF) net health benefit (NHB) at the time of approval and over time as further evidence arose. METHODS FDA-approved oncology drug indications from January 2006 to December 2016 were reviewed to identify clinical trials scorable using the ASCO-VF. Subsequent publications of clinical trials relevant for scoring were identified (until December 2019). Using ASCO-defined thresholds (≤40 for low and ≥45 for substantial benefit), we assessed changes in classification of benefit at 3 years postapproval. RESULTS Fifty-five eligible indications were included. At FDA approval, 40.0% were substantial, 10.9% were intermediate, and 49.1% were low benefit. We then identified 90 subsequent publications relevant to scoring, including primary (28.9%) and secondary endpoint updates (47.8%), safety updates (31.1%), and QoL reporting (47.8%). There was a change from initial classification of benefit in 27.3% of trials (10.9% became substantial, 9.1% became low, and 7.3% became intermediate). These changes were mainly due to updated hazard ratios (36.4%), toxicities (56.4%), new tail-of-the-curve bonus (9.1%), palliation bonus (14.5%), or QoL bonus (18.2%). Overall, at 3 years postapproval, 40.0% were substantial, 9.1% were intermediate, and 50.9% were low benefit. CONCLUSIONS Because there were changes in classification for more than one-quarter of indications, in either direction, reassessing the ASCO-VF NHB as more evidence becomes available may be beneficial to inform clinical shared decision-making. On average, there was no overall improvement in the ASCO-VF NHB with longer follow-up and evolution of evidence.
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Affiliation(s)
- Seanthel Delos Santos
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario
| | - Noah Witzke
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario
| | - Bishal Gyawali
- Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Kingston, Ontario.,School of Medicine, Queen's University, Kingston, Ontario
| | - Vanessa Sarah Arciero
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Amanda Putri Rahmadian
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario
| | - Louis Everest
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario
| | - Matthew C Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.,Department of Medicine, University of Toronto, Toronto, Ontario; and
| | - Kelvin K Chan
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.,Department of Medicine, University of Toronto, Toronto, Ontario; and.,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
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