scholarly journals Investigating the inequalities in route to diagnosis amongst patients with diffuse large B-cell or follicular lymphoma in England

2021 ◽  
Author(s):  
Matthew J. Smith ◽  
Miguel Angel Luque Fernandez ◽  
Aurélien Belot ◽  
Matteo Quartagno ◽  
Audrey Bonaventure ◽  
...  
Keyword(s):  
B Cell ◽  
Odds Ratio ◽  
Empirical Bayes ◽  
Cancer Survival ◽  
Diagnostic Delay ◽  
Population Densities ◽  
Mixed Effect ◽  
Cluster Variation ◽  
Main Association ◽  
Large B Cell

Abstract Introduction Diagnostic delay is associated with lower chances of cancer survival. Underlying comorbidities are known to affect the timely diagnosis of cancer. Diffuse large B-cell (DLBCL) and follicular lymphomas (FL) are primarily diagnosed amongst older patients, who are more likely to have comorbidities. Characteristics of clinical commissioning groups (CCG) are also known to impact diagnostic delay. We assess the association between comorbidities and diagnostic delay amongst patients with DLBCL or FL in England during 2005–2013. Methods Multivariable generalised linear mixed-effect models were used to assess the main association. Empirical Bayes estimates of the random effects were used to explore between-cluster variation. The latent normal joint modelling multiple imputation approach was used to account for partially observed variables. Results We included 30,078 and 15,551 patients diagnosed with DLBCL or FL, respectively. Amongst patients from the same CCG, having multimorbidity was strongly associated with the emergency route to diagnosis (DLBCL: odds ratio 1.56, CI 1.40–1.73; FL: odds ratio 1.80, CI 1.45–2.23). Amongst DLBCL patients, the diagnostic delay was possibly correlated with CCGs that had higher population densities. Conclusions Underlying comorbidity is associated with diagnostic delay amongst patients with DLBCL or FL. Results suggest a possible correlation between CCGs with higher population densities and diagnostic delay of aggressive lymphomas.

scholarly journals The impact of structural factors on diagnostic delay in diffuse large B‐cell lymphoma

2019 ◽  
Vol 8 (4) ◽  
pp. 1416-1422
Author(s):  
Joanna C. Zurko ◽  
Raymond C. Wade ◽  
Amitkumar Mehta
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Diagnostic Delay ◽  
B Cell Lymphoma ◽  
Structural Factors ◽  
Large B Cell Lymphoma ◽  
The Impact ◽  
Large B Cell

scholarly journals Matching-adjusted indirect treatment comparison of liso-cel versus axi-cel in relapsed or refractory large B cell lymphoma

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
David G. Maloney ◽  
John Kuruvilla ◽  
Fei Fei Liu ◽  
Ana Kostic ◽  
Yeonhee Kim ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
B Cell ◽  
Odds Ratio ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Sensitivity Analyses ◽  
Efficacy And Safety ◽  
Bridging Therapy ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background In the absence of randomized studies directly comparing chimeric antigen receptor T cell therapies, this study used matching-adjusted indirect comparisons (MAIC) to evaluate the comparative efficacy and safety of lisocabtagene maraleucel (liso-cel) versus axicabtagene ciloleucel (axi-cel) in patients with relapsed or refractory large B cell lymphoma (LBCL). Methods Primary data sources included individual patient data from the TRANSCEND NHL 001 study (TRANSCEND [NCT02631044]; N = 256 for efficacy set, N = 269 for safety set) for liso-cel and summary-level data from the ZUMA-1 study (NCT02348216; N = 101 for efficacy set, N = 108 for safety set) for axi-cel. Inter-study differences in design, eligibility criteria, baseline characteristics, and outcomes were assessed and aligned to the extent feasible. Clinically relevant prognostic factors were adjusted in a stepwise fashion by ranked order. Since bridging therapy was allowed in TRANSCEND but not ZUMA-1, the initial efficacy and safety analyses included bridging therapy use as a matching factor (TRANSCEND patients who received bridging therapy were removed). Subsequent sensitivity analyses excluded this matching factor. Results The initial analysis showed similar MAIC-weighted efficacy outcomes between TRANSCEND and ZUMA-1 for overall and complete response rates (odds ratio [95% confidence interval (CI)], 1.40 [0.56–3.49] and 1.21 [0.56–2.64], respectively) and for overall survival and progression-free survival (hazard ratio [95% CI], 0.81 [0.44–1.49] and 0.95 [0.58–1.57], respectively). MAIC-weighted safety outcomes favored liso-cel, with significantly lower odds of all-grade and grade ≥ 3 cytokine release syndrome (odds ratio [95% CI], 0.03 [0.01–0.07] and 0.08 [0.01–0.67], respectively) and study-specific neurological events (0.16 [0.08–0.33] and 0.05 [0.02–0.15], respectively). Efficacy and safety outcomes remained similar in sensitivity analyses, which did not include use of bridging therapy as a matching factor. Conclusions After matching and adjusting for clinically relevant prognostic factors, liso-cel demonstrated comparable efficacy and a more favorable safety profile compared with axi-cel in patients with third- or later-line relapsed or refractory LBCL. Trial registration: NCT02631044 and NCT02348216

Importance of Relative Dose Intensity for Survival in Diffuse Large B-Cell Lymphoma Patients Treated with CHOP-Like Regimen

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3605-3605
Author(s):  
Tsuneaki Hirakawa ◽  
Hiroki Yamaguchi ◽  
Seiji Gomi ◽  
Norio Yokose ◽  
Koiti Inokuchi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
B Cell ◽  
Odds Ratio ◽  
Cell Lymphoma ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Relative Dose Intensity ◽  
Large B Cell Lymphoma ◽  
Prophylactic Use ◽  
Large B Cell

Abstract Diffuse large B-cell lymphoma (DLBCL) is the most frequently occurring Non-Hodgkin lymphoma (NHL). Until recently, CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone delivered on a 21-day cycle) was considered as the standard chemotherapy regimen for DLBCL. Recent data have also shown that combining CHOP with Rituximab (R-CHOP) significantly improves survival in DLBCL. It is recognized that delivery of less than full-dose chemotherapy is associated with poor response and shorter survival times. However it is difficult to keep administration of chemotherapy dose and interval due to several side effects such as myelosuppression, infection, and organ dysfunction. Recently relative dose intensity (RDI) defined as total delivered dose of chemotherapy drug per unit time expressed as a percentage of the target dose, had important roll in the treatment outcome. To determine the importance of RDI, we analyzed achievement of RDI in CHOP-like regimen among DLBCL patients. We retrospectively analyzed 203 DLBCL patients treated with CHOP-like regimen as a first line therapy at Nippon Medical School Hospital and related hospital between January 1, 1996 and December 31, 2007. Median age of the patients was 65.6 years (range, 20.5–90.3) at diagnosis. Median duration of observation was 1.9 years (range, 0.1–11.8). 203 patients were classified as international prognostic index (IPI) as follows; Low-Low Intermediate (L-LI) (n=116), High Intermediate-High (HI-H) (n=86), unknown (n=1). They were treated by CHOP (n=47), R-CHOP (n=100), THP (terahydropyranyladriamycin)-COP (n=6), R-THP-COP (n=50). The median RDI of all patients was 75.2%. Increasing RDI correlated with longer survival time (RDI of 70 to <75%, 75 to 79%, and ≥80%, mean survival was 4.6, 5.0 and 5.2 years, respectively). Comparing the patients of RDI ≥80% with those of <80%, the estimated relapse free survival (RFS) and overall survival (OS) was significantly higher in the former (RFS; 81.7% vs 66.4%, p=0.039, OS; 94.1% vs 74.3%, p=0.005). Results of a multivariate Cox regression analyses revealed that RDI of ≥80% (odds ratio 2.495, p=0.040), IPI of L-LI (odds ratio 3.459, p=0.006) and Rituximab (odds ratio 3.554, p=0.005) were independent prognostic factors for OS. Concerning RFS, IPI of L-LI (odds ratio 2.873, p=0.002) and Rituximab (odds ratio 1.989, p=0.044) were independent prognostic factors. On the other hand, RDI of ≥ 80% showed tendency to longer RFS, but it was not statistically significant (odds ratio 1.747, p=0.094). Subsequently we analyzed the reason for the dose reduction an/or chemotherapy delay. Among the reasons, hematological toxicities and febrile neutropenia (FN) resulted in a reduction of treatment intensity significantly (odds ratio 2.550, p=0.007). Prophylactic use of granulocyte colony-stimulating factor (G-CSF) decreased the risk of neutropenic complications and served as increasing the dose intensity (odds ratio 0.436, p=0.007). We demonstrated that increasing RDI was a important prognostic factor for treating DLBCL using CHOP-like regimen. Moreover, prophylactic use of G-CSF to decrease FN had important role for increasing RDI.

Lymphome

Praxis ◽  
2016 ◽  
Vol 105 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Andreas Lohri
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Staging System ◽  
Maligne Lymphome ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Ann Arbor ◽  
Large B Cell

Zusammenfassung. Maligne Lymphome unterteilen sich zwar in über 60 Entitäten, das grosszellige B-Zell-Lymphom, das follikuläre Lymphom, der Hodgkin und das Mantelzell-Lymphom machen aber mehr als die Hälfte aller Lymphome aus. Im revidierten Ann Arbor staging system gelten die Suffixe «A» und «B» nur noch für den Hodgkin. «E» erscheint nur noch bei Stadien I und II. Eine Knochenmarksuntersuchung wird beim Hodgkin nicht mehr verlangt, beim DLBCL (Diffuse large B cell lymphoma) nur, falls das PET keinen Knochenmark-Befall zeigt. Der PET-Untersuchung, speziell dem Interim-PET, kommt eine entscheidende Bedeutung zu. PET-gesteuerte Therapien führen zu weniger Toxizität. Gezielt wirkende Medikamente mit eindrücklicher Wirksamkeit wurden neu zugelassen. Deren Kosten sind hoch. Eine strahlen- und chemotherapiefreie Behandlung maligner Lymphome wird in Zukunft möglich sein.

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