Does Hispanic Origin Affect the Repartition and Outcome of Marginal Zone Lymphoma?

BACKGROUND Marginal zone lymphoma (MZL) is a rare indolent lymphoma that represents about 7% of all Non-Hodgkin's lymphoma (NHL). MZL is divided into 3 subtypes with different repartition based on primary anatomical site: 60% extra-nodal (EMZL), 32% nodal (NMZL), and 9% Splenic (SMZL) (CA Cancer J Clin, PMID: 27618563). While asymptomatic MZL is often left untreated, there are no clear guidelines regarding the first-line treatment of each subtype (Future Oncol, PMID: 29260925). Although the survival rate of MZL is superior to other NHL with a 5-year survival of 83-91%, cancer remains a leading cause of death among Hispanics (CA Cancer J Clin, PMID: 7618563; Natl Vital Stat Rep, PMID: 32501203). Our study aimed at establishing the impact of Hispanic origin on the repartition and outcomes of MZL. METHODS: Data from the Texas Cancer Registry were utilized including adult patients diagnosed with NHL between 2006-2016. The third edition of the International Classification of Diseases for Oncology (ICD-O-3) was used to select patients diagnosed with MZL and all patient information was de-identified. Standard demographic information and outcomes were obtained and summarized in tables. The significance of variance of categorical outcomes by ethnicity was calculated using Fisher's Exact test or T-test (statistical significance of 5%). Survival time was calculated from the date of primary diagnosis to date of death. Kaplan-Meier curves were used for survival distributions and the significance of variation in median survival with ethnicity was assessed with log-rank testing. RESULTS AND DISCUSSION Of the 43166 total cases of NHL, 3529 (8.2%) were MZL, of which 82%(n=2867) were Non-Hispanics (NH) and 18%(n=662) were Hispanics (H). When comparing the number of cases among each subtype of MZL in H vs NH, there were 408 vs 1570 cases of EMZL, 174 vs 1022 cases of NMZL, and 38 vs 275cases of SMZL respectively. The median age at diagnosis was 63.2 for H and 66.7 for NH. Younger age at diagnosis was noted in H compared to NH for EMZL (60.4 vs 65, p<0.001) and NMZL (64.4 vs 66.7, p=0.004). There was no statistical difference between genders. About 51.6% of H was in the 20-100% poverty index bracket compared to 20.1% in NH (p< 0.0001). The most prevalent insurance type was Medicare in both groups (H: 37%, NH: 47.2%) and the uninsured rate was higher in H (12.4 vs 3.2 p<0.02). Most individuals regardless of their ethnicity lived in the metro area (87%), non-border area (85%). EMZL was more prevalent in H (61% vs 54%, p=0.001) whereas NMZL (26,2% vs 35,6%, p=0.0005) and SMZL (5.7% vs 9.5% p=0.002) where more prevalent in NH. Regarding systemic treatment, there was no statistically significant difference between the two groups irrespective of MZL subtype; patients were treated with single or multiple agent chemotherapy as it follows: NMZL 34% H vs 27% NH, EMZL 16% H vs 15.5 NH, SMZL 24% H vs 25% NH. Beam radiation was more frequent in H for both EMZL (20% vs 14.6% p=0.031) and NMZL (3.4% vs 0.2%, p=0.02). Median survival in years was very similar in H vs NH (EMZL: 9 vs 9.3; NMZL: 7.6 vs 7.6; SMZL: 7.3 vs 8.3). Furthermore, there was no statistically significant difference in the overall survival probability for the 10-year follow up period (EMZL: p=0.46, NMZL: p=0.69; and SMZL: p=0.74). Demographics and results are summarized in Table 1. CONCLUSION Despite differences in demographics, poverty index, insurance coverage, and prevalence of each subtype of MZL in H compared to NH, there was no statistically significant difference in overall survival probability. These findings also suggest that the complex correlation between MZL biology, ethnicity and oncologic care can serve as the equalizer of disparities that lead to long term balanced outcomes. More in depth studies are needed to further clarify. Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

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Disparities in Mantle Cell Lymphoma Outcomes in Hispanics: A Population Based Analysis in Texas and Florida

Blood ◽

10.1182/blood-2021-145937 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4081-4081

Author(s):

Brian Warnecke ◽

Daniel Rosas ◽

Alexandra Wehbe ◽

Qianqian Liu ◽

Joel E Michalek ◽

...

Keyword(s):

Survival Time ◽

Median Survival ◽

Survival Probability ◽

Median Survival Time ◽

Research Funding ◽

Cell Lymphoma ◽

Poverty Index ◽

Significant Difference ◽

Mantle Cell ◽

Age Of Diagnosis

Abstract Introduction: Mantle cell lymphoma (MCL) is a rare, aggressive type of B-cell non-Hodgkin lymphoma (NHL) that accounts for approximately 7% of adult NHL's in the United States. (JCO PMID: 9704731)Although recent advancements in treatment have improved survival, prognosis remains poor. (Blood PMID: 30154113) There have been several recent studies demonstrating ethnic disparities in MCL, however, there is a paucity of survival outcome data in Hispanic (H) patients with MCL. (CLMLPMID: 31029647) The purpose of this study was to compare the demographics, treatment patterns, and survival outcomes of H and Non-Hispanic (NH) patients diagnosed with MCL, and to contrast Hispanic cohorts between Texas (TX) and Florida (FL). Methods: This is a retrospective cohort study of patients diagnosed with lymphoma (Hodgkin and Non-Hodgkin) from the Texas Cancer Registry (TCR) and the Florida Cancer Data System (FCDS) from 2006-2017. This particular analysis focuses on patients with diagnosis of MCL. Key variables included gender, race, ethnicity, birthplace, dates of diagnosis and death, primary payer at diagnosis, poverty index, stage at diagnosis, and type of treatment. The significance of variation in distribution of categorical outcomes with ethnicity [H, NH] was assessed with Fisher's Exact tests or Pearson's Chi-square as appropriate; age was assessed with T-test or Wilcoxon. Survival time was measured in years from date of primary diagnosis to date of death. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. All statistical testing was two-sided with a significance level of 0.05. Results: We identified a total 4619 (2078 TX, 2541 FL) patients with MCL. 669 (15%) were H and 3950 (85%) were NH. In TX, the median age of diagnosis was 65.6 years (y) in H and 68.3 y in NH (p < 0.001). In FL, the median age of diagnosis was 67.56 in H and 70.06 in NH (p < 0.001). There was a statistically significant difference in poverty index between the cohorts in both TX and FL. The majority of H (50%) in TX were in the 20-100% bracket while the majority of NH (36%) in TX were in the 10-19.9% bracket (p < 0.001). The majority of H (39%) in FL were in the 10-19.9% bracket, and the majority of NH (35%) were also in the 10-19.9% bracket (p < 0.001). Interestingly, there were only 30% of H in FL in the 20-100% bracket. There was a statistically significant difference in insurance status with the most frequent insurance being government-sponsored insurance for H in TX (48%), NH in TX (58%), H in FL (48%), and NH in FL (62%). Patients were without insurance at time of diagnosis in 14% of H in TX and 9% of H in FL, in contrast to 4% of NH in TX and 2% NH in FL. The most common stage at diagnosis in both cohorts in TX and FL was Stage III/IV with 68% H in TX vs 65% NH in TX (p = 0.746) and 69% H in FL vs 67% NH in FL (p = 0.316). The most frequent chemotherapy regimen included multiple agents for all cohorts, 43% H in TX vs 37% NH in TX (p = 0.063), and 48% H in FL vs 42% NH in FL (p = 0.695). Median survival time was 3.4 y H in TX, 3.5 y NH in TX, 4.1 y H in FL, and 4.3 y NH in FL. The survival probability at 2 years was 0.636, 0.640, 0.707, 0.675 for H in TX, NH in TX, H in FL, and NH in FL, respectively. The survival probability at 5 years was 0.371, 0.379, 0.445, 0.459 for H in TX, NH in TX, H in FL, and NH in FL, respectively. The survival probability at 10 years was 0.147, 0.118, 0.276, 0.245 for H in TX, NH in TX, H in FL, and NH in FL, respectively. There was no statistically significant difference in survival probability at 2, 5, or 10 years between H and NH in TX (p = 0.68) and FL (p = 0.72). Conclusions: Our study of patients diagnosed with MCL demonstrated statistically significant differences between H and NH patients in median age of diagnosis, poverty index, and insurance status at diagnosis. These disparities were observed in patients between the cancer registries in both states. Although there were no statistically significant differences in median survival time or survival probability at 2, 5, and 10 years among the H cohorts within each state, we observed intriguing data when the two states were compared. Strikingly, H in TX had much lower survival probability at 2, 5, and 10 years compared to H in FL. In addition, H in TX were noted to have a shorter median survival time compared to H in FL. These disparities may be a direct reflection of the significantly higher rates of poverty and lack of insurance among H in TX compared to H in FL. Figure 1 Figure 1. Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Astra Zeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Epizyme: Research Funding.

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Demographic Differences in the Treatment and Mortality of Lymphoplasmacytic Lymphoma in Texas: Does Ethnicity Play Any Role?

Blood ◽

10.1182/blood-2020-138604 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 17-20

Author(s):

Michael E Auster ◽

Snegha Ananth ◽

Lakene Raissa Djoufack Djoumessi ◽

Qianqian Liu ◽

Joel E Michalek ◽

...

Keyword(s):

Survival Time ◽

Median Survival ◽

Survival Probability ◽

Research Funding ◽

Statistical Testing ◽

P Value ◽

Hispanic Paradox ◽

Lymphoplasmacytic Lymphoma ◽

Poverty Index ◽

Significant Difference

BACKGROUND: Social determinants and demographics exert an overwhelming influence on the health of the individual and overall population health (J Am Geriatr Soc. PMID: 28369694).The Hispanic paradox has been well characterized, demonstrating that although Hispanic patients (HisP) have higher disability, depressive, metabolic, and inflammatory risk when compared to non-Hispanic (nHisP), they continue to live long lives (J Health Soc Behav. PMID: 31771347). The characterization of these differences in hematology has not been well documented. This study seeks to characterize Lymphoplasmacytic lymphoma (LPL). LPL is a rare lymphoma of B-cell origin demonstrating an incidence of 1000 to 1500 new cases per year in the United States (Hematol Oncol Clin North Am, PMID: 31229160). Epidemiological research is not well documented in this lymphoma subtype, especially regarding the HisP. Given that Texas has the second highest state with HisP in the country (US Census Bureau), we studied the demographics of this disease and specifically researched the demographics, treatment patterns and survival between HisP and nHisP in Texas. METHODS: This is a retrospective study of a cohort of patients diagnosed with lymphoma (Hodgkin and Non-Hodgkin) from the Texas Cancer Registry (TCR) database. Patient's included were those >18 years of age during 2006-2016 and this study focused on the LPL subset. Standard demographic variables collected include gender, race, ethnicity, birthplace, occupation, dates at diagnosis and death, primary payer at diagnosis, subtype of lymphoma, stage, type of treatment, poverty index, and vitality status among others. The significance of variation in the distribution of categorical outcomes with ethnicity (HisP, nHisP) was assessed with Fisher's Exact tests or Pearson's Chi-square tests as appropriate; age was assessed with T-tests or Wilcoxon tests as appropriate. Survival time was measured in years from date of primary diagnosis to date of death. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. All statistical testing was two-sided with a significance level of 5%. RESULTS AND DISCUSSION: Out of 490 patients diagnosed with LPL, 64 were HisP and 426 nHisP. Of this population, the HisP had a higher percentage of patients at the higher end of the poverty index (42.4% to 20% with p value <0.001) and higher rates of being uninsured or on Medicare (51.6 to 43.4% with p value <0.001). There were no statistically significant differences in the staging at the time of diagnosis between the two groups, mostly III/IV (HisP 65.6% to nHisP 62% P value 0.387). Treatment modalities differed slightly in that the nHisP populations were more likely to receive beam radiation than the HisP (3.4% to 0, P value 0.005) but overall chemotherapy differences were not statistically significant. The median survival time in years for HisP and nHisP was 6.8 and 7.6 respectively, and the overall survival probability was not significantly different with a P value of 0.59. The survival probabilities at 2, 5 and 10 years between HisP and nHisP were respectively, 0.657 with Confidence interval (CI)[0.545,0.792], 0.573 CI [0.455,0.722], 0.448 CI [0.32,0.627], compared to 0.766 CI [0.723,0.811], 0.620 CI [0.566,0.68], 0.129 CI [0.042,0.389]. CONCLUSION: In this study we show that in Texas, for those diagnosed with LPL, there is a statistically significant difference in the rates of poverty and insurance when comparing Hisp to nHisP. While this is true, there is no clear statistically significant difference in overall treatment or survival probability, which is consistent with the Hispanic paradox. Due to the rarity of this disease, the population size is limited which may skew the data. More research is needed in order to further characterize the differences between these two populations and determine what can be done to narrow these differences. Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

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Population-Based Analysis of Hispanic Vs Non-Hispanic Patients Diagnosed with Hodgkin Lymphoma in Texas and Florida

Blood ◽

10.1182/blood-2021-152695 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4531-4531

Author(s):

Abhishek Pandya ◽

Munaf Al-Kadhimi ◽

Qianqian Liu ◽

Joel E Michalek ◽

Adolfo Enrique Diaz Duque

Keyword(s):

Survival Time ◽

Hodgkin Lymphoma ◽

Median Survival ◽

Survival Probability ◽

Research Funding ◽

Poverty Index ◽

Survival Probabilities ◽

Kaplan Meier ◽

Significant Difference ◽

Race Ethnicity

Abstract Introduction: Classical Hodgkin lymphoma (cHL) accounts for about 90% of cases of HL. (Medicine PMID 26107683) Within cHL, there are 4 main histologic subtypes; the incidence of cHL varies based on age, race/ethnicity, geography, socioeconomic factors, Epstein Barr virus status, and the prevalence of HIV/AIDS. (Adv HematologyPMID 21197477) Considerable disparities exist in the incidence and survival rates between Hispanic (H) and non-Hispanic (NH) populations with cHL. (Ann Oncol PMID 22241896) Between 2013-2017, the incidence rate of cHL in Florida (FL) was 457 per 100,00, and in Texas (TX), it was 408 per 100,000. (North American Association of Central Cancer Registries, 2020) Our study aims to determine demographics, treatment outcomes, and survival outcomes of H and NH patients diagnosed with cHL in TX and FL. Methods: This is a retrospective study of a cohort of patients diagnosed with lymphoma (Hodgkin and Non-Hodgkin) from the Texas Cancer Registry (TCR) and the Florida Cancer Data System (FCDS) between 2006-2017. The third edition of the International Classification of Diseases for Oncology (ICD-O-3) was used to identify patient with cHL. Variables include gender, race, ethnicity, birthplace, occupation, dates at diagnosis and death, primary payer at diagnosis, subtype of lymphoma, stage, type of treatment, poverty index, and vitality status. The significance of variation in the distribution of categorical outcomes with ethnicity (H, NH) was assessed with Fisher's Exact tests or Pearson's Chi-square tests as appropriate; age was assessed with T-tests or Wilcoxon tests as appropriate. Survival time was measured in years from date of primary diagnosis to the date of death. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. At risk tables were computed based on the Kaplan-Meier estimate of the survival curve. All statistical testing was two-sided with a significance level of 5%. Corrections for multiple testing were not applied. Results: There were 6152 (1266 H, 4886 NH) patients in FL and 6241(1736 H, 4505 NH) patients in TX identified with cHL. In FL, the median age at diagnosis was 44.8 years (y) for H vs 48.3y for NH (p < 0.001) while in TX, there was no statistically significant difference (45.8y H, 44.9y NH, p = 0.102). In FL, there was no statistically significant difference among females (44% H, 46% NH, p = 0.136) and males (56% H, 53% NH, p = 0.136) while there was one in TX among females (43% H, 45% NH, p = 0.048) and males (58% H, 55% NH, p = 0.048). In FL, the majority of H (40.5%) and NH (36.6%) were in the 10-19.9% poverty index (p<0.001). In TX, the majority of H (51.2%) were in the 20-100% poverty index while the majority of NH (32.2%) were in the 10-19.9% index (p<0.001). In FL, 10.7% H and 6.4% NH were without insurance at time of diagnosis (p<0.001) while in TX, 23.8% H and 11.7% NH were in that position (p<0.001). The most common stage of diagnosis was stage III/IV with 37.8% H vs 34.2% NH in FL (p<0.001) and 44.1% H vs 34.6% NH in TX (p<0001). In FL, median survival time was 10.6y H vs 11.4y NH, while in TX, it was 10.3y H vs 10.4y NH. In FL, the survival probabilities at years 2, 5, and 10 were 0.858, 0.774, and 0.550 for H vs 0.808, 0.696, and 0.545 for NH, respectively. In TX, the survival probabilities at years 2, 5, and 10 were 0.758, 0.674, and 0.522 for H vs 0.828, 0.743, and 0.579 for NH, respectively. The survival probability at years 2, 5, and 10 were higher for H compared to NH in FL (p = 0.0018), however the survival probability at years 2, 5, and 10 were lower for H compared to NH in TX (p < 0.0001). Conclusion: Our study of patients diagnosed with cHL demonstrated several statistically significant differences among H and NH patients in both states. Importantly, H patients in TX had a statistically significant lower survival probability at 2, 5, and 10y compared to NH patients. A reason for this could be the more significant number of uninsured H as compared to NH patients. Conversely, H patients in FL had a statistically significant higher survival probability at 2 and 5y compared to NH patients, partly explained by the lower median age of diagnosis of H patients compared to NH patients. There is a need for further analysis that could help explain the disparities among the different ethnicities. Figure 1 Figure 1. Disclosures Diaz Duque: Astra Zeneca: Research Funding; Epizyme: Consultancy; Morphosys: Speakers Bureau; Incyte: Consultancy; ADCT: Consultancy; Hutchinson Pharmaceuticals: Research Funding.

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Stratification Approach for Splenic Marginal Zone Lymphoma Based on Hemoglobin, Platelet Count, High LDH and Extrahilar Lymphadenopathy: The HPLL/ABC System

Blood ◽

10.1182/blood.v118.21.1583.1583 ◽

2011 ◽

Vol 118 (21) ◽

pp. 1583-1583 ◽

Cited By ~ 1

Author(s):

Carlos Montalban ◽

Victor Abraira ◽

Luca Arcaini ◽

Eva Domingo-Domenech ◽

Pablo Guisado-Vasco ◽

...

Keyword(s):

Cancer Research ◽

Platelet Count ◽

Research Funding ◽

Marginal Zone ◽

Risk Groups ◽

Marginal Zone Lymphoma ◽

Splenic Marginal Zone Lymphoma ◽

Training Set ◽

Conditioning Treatment ◽

Significant Difference

Abstract Abstract 1583 Splenic Marginal Zone Lymphoma (SMZL) is a distinct lymphoma included in the WHO 2008 classification. Ann Arbor staging system is not adequate to stratify SMZL patients into risk groups, as blood and bone marrow are usually involved. Further, there are neither established criteria for starting treatment nor gold standard treatment. Herein we report an international retrospective study on 593 SMZL patients aimed to identify which factors could influence starting treatment and which could allow stratify risk categories. Logistic regression was used to identify the factors that have conditioned treatment in the whole series and Cox regression for factors influencing Lymphoma Specific Survival (LSS) in a training set of 336 patients. The variables used were age, hemoglobin level and platelet count (as continuous variables) and sex, low albumin serum level (<3 gr/dl), high LDH and β2microglobulin, serum monoclonal component, DAT positivity, active autoimmune anemia, HCV positivity, lymphadenopathy (other than in hepatic and splenic hila) and extranodal involvement. The final model for LSS was used to produce a prognostic index (PI) and allowed to divide the patients in three risk groups applying cutpoints at the 20th and 80th centiles in patients with events. The resulting stratification was validated in another set of 227 patients. Also, the stratification was compared with the Interguppo Italiano Linfomi (IIL) score in the set of 450 patients in whom the required data were available, using the extension net reclassification improvement (NRI). Hemoglobin (p=0.000), extrahilar lymphadenopathy (p=0.000), and HCV positivity (p=0.001), were the factors independently conditioning treatment. Untreated patients had a significant longer LSS than treated patients (p=0.000). In the treated group there were no differences in LSS according to the type of therapy (splenectomy, chemotherapy, rituximab or their combinations) (Figure A). The low number of rituximab treated patients (n=39) precluded statistically reliable conclusions. In the training set, haemoglobin (p=0.003), platelet count (p=0.043), high LDH (p=0.011) and extrahilar lymphadenopathy (p=0.020) were the factors independently influencing LSS. The resulting PI was: 0.6 × platelet count (in hundreds of thousands/mm3) + 0.2 × hemoglobin (g/dl) − 1 × high LDH (1 when LDH above normal, 0 when normal) – 0.75 × extrahilar lymphadenopathy (1 when present, 0 when absent). Applying the cut points a low, intermediate and high risk groups with significantly different 5 year LSS of 0.94, 0.78 and 0.67, respectively, were identified (Figure B). In the validation set the system also separated 3 groups with significant different 5 year LSS of 0.96, 0.88 and 0.44, respectively. This stratification was named HPLL after the determinant factors (H emoglobin, P latelet count, high L DH, L ymphadenopathy) and the resulting risk groups HPLLA, HPLLB and HPLLC. In the comparison HPLL/ABC system separated 3 groups with significantly different LSS, whereas in the IIL score there was no significant difference between the low and intermediate risk groups (p=0,102). Using as reclassification calibration statistics the Hosmer-Lemeshow test, HPLL/ABC (χ2 =1.48; p=0.475) showed a better fit than the IIL score (χ2= 3.339; p=0.118) indicating that HPLL/ABC discriminated better the risk groups. In this large SMZL series, haemoglobin, extrahilar lymphadenopathy and HCV positivity were the factors independently conditioning treatment. The combination of hemoglobin, platelet count, high LDH and extrahilar lymphadenopathy stratify the patients in three groups with significantly different outcome. This system may be helpful to select risk-tailored treatment approaches. Disclosures: Montalban: Red Temática de Investigación Cooperativa en Cancer (RETICC): Research Funding; Asociación Española contra el Cancer: Research Funding. Mollejo:Red Temática de Investigación Cooperativa en Cancer (RETICC): Research Funding; Asociación Española contra el Cancer: Research Funding. Piris:Red Temática de Investigación Cooperativa en Cancer (RETICC): Research Funding; Asociación Española contra el Cancer: Research Funding.

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Understanding Oncological Disparities in Mycosis Fungoides within Hispanic Enriched Communities

Blood ◽

10.1182/blood-2021-151891 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 5016-5016

Author(s):

Rodolfo Garza-Morales ◽

Carolina Velez-Mejia ◽

Qianqian Liu ◽

Joel E Michalek ◽

Adolfo Enrique Diaz Duque

Keyword(s):

Survival Time ◽

Mycosis Fungoides ◽

Survival Probability ◽

Research Funding ◽

Private Insurance ◽

Statistical Testing ◽

Insurance Status ◽

Poverty Index ◽

Significant Difference ◽

Age Of Diagnosis

Abstract Introduction Cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of extra-nodal non-Hodgkin's lymphomas that are characterized by a cutaneous infiltration of malignant monoclonal T lymphocytes (F1000Res. PMID 27540476). Among them, Mycosis Fungoides (MF) is the most predominant subtype, accounting for 50-65% of cases (An Bras Dermatol. PMID 30066762). Although most patients with MF are Non-Hispanic (NH), from the 1970s to 2010s there has been an increase in the percentage of HI patients (4% to 11%, respectively) (J Eur Acad Dermatol Venereol. PMID 32141115). Racial disparities in MF have been studied, but they are still poorly understood in Hispanic (HI) populations and further studies are needed to evaluate the role of ethnicity in MF outcomes. In this study, we focused on two communities, Texas (TX) and Florida (FL), which have a strong HI representation. According to the U.S 2020 Census, 39% of the population of TX and 26% of the population of FL are HI. Therefore, the purpose of this study is to compare demographics, treatment patterns, and survival outcomes of HI and NH patients diagnosed with MF, and to contrast HI cohorts between TX and FL. Methods This is a retrospective analysis of patients diagnosed and recorded in the Texas Cancer Registry and the Florida Cancer Data System from years (y) 2006-2017. Inclusion criteria was histopathologic proven MF. Patients were divided into HI and NH for comparison. Standard demographic, socioeconomic, clinical, and survival variables were reviewed. All statistical testing was determined using Fisher's Exact test, Pearson's Chi-square test, T-test or Wilcoxon test, as appropriate. Survival time was measured using the day of diagnosis to last date of follow up or death. Survival distribution were calculated based on Kaplan-Meier curves. All statistical testing was two-sided with a significance level of 5%. Results We identified a total 2566 (1373 TX, 1193 FL) patients with MF. 319 (12%) were HI and 2247 (88%) were NH. The median age of diagnosis in our TX population was 50 y in HI and 59 y in NH (p < 0.001). In FL, the median age of diagnosis was 57 y in HI and 65 y in NH (p <0.001). There was a statistically significant difference in poverty index between HI and NH in both TX and FL. The majority of HI (42%) in TX were in the 20-100% bracket while the majority of NH (28%) in TX were in the 10-19.9% bracket (p<0.001). In contrast, the majority of HI (36%) in FL were in the 10-19.9% bracket while the majority of NH (34%) in FL were also in the 10-19.9% bracket (p<0.001). In patient where insurance status was known, there was a statistically significant difference in insurance status with the most frequent insurance being private insurance for HI in TX (28%) and NH in TX (24%) (p<0.001). In FL, HI (39%) had private insurance whereas NH (30%) had government-sponsored insurance (p<0.001). The most common stage at diagnosis in both cohorts in TX and FL was Stage I with 56% HI in TX vs 56% NH in TX (p=0.526) and 54% HI in FL vs 44% NH in FL (p=0.052). In both cohorts, majority of HI (71%) in TX, and NH (72%) in TX (p=0.38), HI (73%) in FL and NH (81%) (p=0.156) did not undergo chemotherapy. In TX, median survival (MS) was 10.8 y for HI, and 9.7y for NH; whereas in FL, MS was not reached for HI, and for NH was 8.3y. The survival probability at 2 y was 0.921, 0.904, 0.875, 0.836 for HI in TX, NH in TX, HI in FL, and NH in FL, respectively. The survival probability at 5 y was 0.819, 0.775, 0.728, 0.665 for HI in TX, NH in TX, HI in FL, and NH in FL, respectively. The survival probability at 10 y was 0.714, 0.440, 0.512, 0.451 for HI in TX, NH in TX, HI in FL, and NH in FL, respectively. There was no statistically significant difference in overall survival (OS) probability between HI and NH in TX (p = 0.079) and FL (p = 0.28). Conclusions In this study, we evaluated ethnic disparities in MF, we chose to study TX and FL, two states that have a strong HI representation. In both populations, we found a statistically significant difference between HI and NH in poverty index and insurance status. Although there were no statistically significant differences in median survival time or survival probability at 2, 5, and 10 y among the HI and NH cohorts within each state, we observed that NH and HI in FL had a lower survival probability at 2, 5, and 10 y when compared to NH and HI in TX. Moreover, NH in TX had a much lower OS probability when compared to HI. These disparities may be a direct reflection of the significantly higher rates of poverty among HI in FL compared to HI in TX. Figure 1 Figure 1. Disclosures Diaz Duque: Incyte: Consultancy; Morphosys: Speakers Bureau; Astra Zeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Epizyme: Consultancy; ADCT: Consultancy.

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Ethnic Disparities in Hodgkin's Lymphoma (HL): A Large-Scale Population Based Analysis of Hispanics with HL in Texas

Blood ◽

10.1182/blood-2020-137230 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 29-30

Author(s):

Sushanth Kakarla ◽

Gerardo Manuel Rosas ◽

Sarah Allison Smith ◽

Brian Warnecke ◽

Joel E Michalek ◽

...

Keyword(s):

Overall Survival ◽

Survival Time ◽

Survival Probability ◽

Research Funding ◽

Private Insurance ◽

Statistical Testing ◽

Statistical Computing ◽

P Value ◽

Poverty Index ◽

Kaplan Meier

BACKGROUND: It is estimated that 8480 persons in USA will be diagnosed with Hodgkin Lymphoma (HL) in 2020 accounting to approximately 0.5% of all new cancer diagnoses. The advent of new treatment options has improved the outcomes of this disease and 5-year relative survival rate is 87.4% currently. However, studies have shown that outcomes of HL have been worse in Hispanics (Annals of Oncology, PMID: 22241896) especially in late stage disease and HI experience up to a 35% higher risk of HL specific mortality than whites (AACR,PMID: 26826029). There is an unmet need in the field and dossiers on underrepresented ethnic minorities need to be carefully considered, compared to existing data. Our study aims to compare survival outcomes in Hispanics (HI) vs Non-Hispanics (NH) with HL and to our knowledge this is the largest cohort of patients from an area that represents a large proportion of HI population in the USA. METHODS: This is a retrospective study that examines HL patients obtained from Texas Cancer Registry (TCR) database between 2006-2016 and identified by the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. All patient data was provided to us de-identified. Standard demographic variables collected include gender, race, ethnicity, dates at diagnosis and death, primary payer at diagnosis, subtype of lymphoma, stage, treatment modality, poverty index among others. Categorical outcomes were summarized with frequencies and percentages while age (years), the only continuously distributed outcome was summarized with the mean and standard deviation. The significance of variation in the distribution of categorical outcomes with ethnicity (HI vs NH) was assessed with Fisher's Exact tests or Pearson's Chi-square tests as appropriate; age was assessed with T-tests or Wilcoxon tests as appropriate. Survival time (years) was measured from date of primary diagnosis to death. Patients not coded as dead were considered censored on survival time at the date last seen. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. At risk tables were computed based on the Kaplan-Meier estimate of the survival curve. All statistical testing was two-sided with a significance level of 5%. Corrections for multiple testing were not applied. The R language [R Core Team (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria] was used throughout. RESULTS: We identified 6353 patients with HL, of which 1843 were HI (29%), 4510 NH (71%). Median age of diagnosis in HI was 41.3 vs 42.3 in NH (p = 0.084). Males were more frequently affected, 56.5% in HI vs 54.8 in NH (p = 0.213). Most frequent poverty index bracket for HI was between 20-100% vs 10-19.9% for NH (p < 0.001). Most frequent payment model amongst both groups was private insurance with 28.1% in HI vs 45.1% in NH (p < 0.001). Metro/non-border most frequent locality amongst both groups (p value n/a) with Harris county accounting to 15.7% of HL in HI vs 16.5% of HL in NH. Bexar county accounted for 12.5% of HL in HI vs 5.2% of HL in NH. Most common stage at diagnosis in both groups was III/IV with 43% in HI vs 33.7% in NH (p < 0.001). In both groups most frequent chemotherapy included multiple agents, 57.1% in HI vs 48.8% in NH (p < 0.001). Majority in both groups neither got any radiation, 77% in HI vs 76.5% in NH (p = 0.208) nor hematologic transplant, 92% in HI vs 88.6% in NH (p = 0.01). We found the median overall survival time in HI was 10.5 years vs 10.8 years in NH; the overall survival probability for HI vs NH at 2 years was 0.8 [CI 0.771-0.811] vs 0.85 [CI 0.83-0.853], at 5 years was 0.72 [CI 0.694-0.743] vs 0.77 [CI 0.753-0.782] and at 10 years was 0.60 [CI 0.544-0.646] vs 0.65 [CI 0.615-0.679]. CONCLUSION: Our study demonstrates that amongst the population of Texas, HI patients with HL have a statistically significant worse overall survival probability (p value < 0.0001) when compared to NH patients with HL. It is of paramount importance that outcomes for all racial and ethnic groups continue to improve but very little is known about the basis for these differences. This warrants a deeper investigation into the biological and non-biological determinants for these differences. Figure Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

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Clinical features and possible prognostic factors in patients with Marginal Zone Lymphoma: Retrospective analysis from two centers

10.21203/rs.3.rs-311979/v1 ◽

2021 ◽

Author(s):

Pınar Akyol ◽

Abdulkerim Yıldız ◽

Murat Albayrak ◽

Murat Yıldırım ◽

Mesut Tığlıoğlu ◽

...

Keyword(s):

Overall Survival ◽

Platelet Count ◽

Marginal Zone ◽

Marginal Zone Lymphoma ◽

Splenic Marginal Zone Lymphoma ◽

Need For Treatment ◽

Significant Difference ◽

Hematological And Biochemical Parameters ◽

Nodal Marginal Zone Lymphoma ◽

The Impact

Abstract Objectives Marginal zone lymphoma accounts 5%-17% of all non-Hodgkin lymphomas and has an indolent clinical course. The parameters that predict prognosis and the need for treatment are still unclear. The aim of the current study was to examine the impact of parameters on the course of disease and the need for treatment in marginal zone lymphoma. Methods A retrospective study was conducted with marginal zone lymphoma patients in the two centres between 2010 and 2018. The demographic and disease characteristics, and also hematological and biochemical parameters at the time of diagnosis were examined. The effect of the parameters on overall survival and need for treatment were analyzed. Results During the follow-up, 25 patients required treatment and 15 patiens were followed up without treatment. Overall survival was significantly higher in patients with nodal marginal zone lymphoma than in extranodal and splenic marginal zone lymphoma patients. overall survival of patients who required treatment was 92.9 months while untreated patients was 58.4 months and there was no significant difference among the groups. The platelet count of untreated patients at the time of diagnosis were significantly higher than patients who received treatment. No significant relationship was found between any parameter and overall survival. Conclusions We demonstrated platelet count at the time of diagnosis as a predictive factor for future treatment need. It is an objective and simple blood test that may be helpful to predict the course of the disease although further studies are warranted.

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Bendamustine-Rituximab Does Not Improve Survival over Rituximab Monotherapy for Older Patients with Nodal or Splenic Marginal Zone Lymphoma

Blood ◽

10.1182/blood-2019-121841 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2824-2824

Author(s):

Adam J Olszewski ◽

Thomas A Ollila ◽

John L. Reagan

Keyword(s):

Propensity Score ◽

Older Patients ◽

Research Funding ◽

Marginal Zone ◽

Single Agent ◽

Marginal Zone Lymphoma ◽

First Line ◽

Benefit Ratio ◽

Significant Difference ◽

Medicare Spending

Background: Nodal and splenic marginal zone lymphomas (NMZL/SMZL) are rare, usually disseminated, and typically diagnosed in older patients (median age 69 years). They are increasingly treated with first-line bendamustine/rituximab (BR) based on phase 3 trials that pooled various B-cell indolent lymphomas (Rummel et al., Lancet 2013). However, NMZL and SMZL have unique biology and clinical course. In this context, without histology-specific evidence, the risk/benefit ratio of BR over single-agent rituximab (R) in SMZL/NMZL is uncertain. Our objective was to examine treatment patterns, and to compare survival and toxicity outcomes of BR versus (vs.) R, using population-based data. Methods: Using Medicare claims linked to cancer registry data covering ~34% of the US population (SEER-Medicare), we identified all SMZL/NMZL patients age ≥65 who received 1st line R or BR between 2009-2016 (after approval of bendamustine) and had complete Medicare records. We used a propensity score to generate "pseudo-randomized" cohorts (pooled, including NMZL and SMZL, and histology -specific for NMZL and SMZL), balancing patient and disease characteristics: age, sex, race, comorbidities (including kidney disease and heart failure), performance status, lymphoma stage, B symptoms, prior splenectomy, anemia (including autoimmune hemolytic), transfusions, hospitalizations, and time from diagnosis to therapy. In the balanced pseudo-randomized cohorts, we compared event-free survival (EFS, defined as 2nd line chemotherapy, splenectomy, hospice, or death) and overall survival (OS) from the start of therapy, risk of major toxicities (hospitalization, transfusions), and inflation-adjusted Medicare spending. Outcome models report hazard ratios (HR) or risk ratios (RR) with 95% confidence intervals (95%CI), and marginal means for costs. Results: Among 1,315 patients (901 with NMZL and 414 with SMZL), median age was 78 years [y], and there were 52% women. About half of patients received first-line R every year, but the proportion treated with BR increased from 4% in 2009 to 23% in 2016 (Fig. A). In the pooled NMZL/SMZL cohort of patients receiving BR or R (N=926), those treated with BR were on average younger, more likely to have NMZL, stage 2-4 lymphoma, and B symptoms. With median follow-up 3.8 y, median EFS was 4.3 y (95%CI, 3.5-5.1) for NMZL, and 4.5 y (95%CI, 3.8-6.5) for SMZL. Median OS was 5.7 y (95%CI, 4.9-6.7) in NMZL, and 5.2 y (95%CI, 4.4-6.7) in SMZL. After balancing the confounders, there was no significant difference in either EFS (HR for BR, 1.00; 95%CI, 0.76-1.30, P=.98) or OS (HR, 1.14; 95%CI, 0.85-1.53; P=.38). Toxicities were higher with BR, including hospitalizations (RR, 1.46; 95%CI, 1.14-1.87; P=.003) and transfusions (RR, 2.35; 95%CI, 1.55-3.56; P<.001). Mean Medicare spending within 1 year from diagnosis was higher after BR (mean $83,480) than R (mean $53,776; P<.001). A sensitivity analysis showed that >50% of BR patients would need to have an unobserved risk factor doubling their mortality to explain lack of OS benefit. We then fitted separate propensity score models in NMZL and SMZL. In the comparative NMZL cohort (N=609), 434 patients (71%) received R, and 175 (29%) received BR. We observed no significant difference in either EFS (HR for BR, 0.93; 95%CI, 0.68-1.29; P=.67; Fig. B) or OS (HR, 1.16; 95%CI, 0.82-1.63; P=.40), whereas toxicities and costs were consistently higher with BR. In the comparative SMZL cohort (N=317), 272 patients (86%) received R, and 45 (14%) received BR. Again, there was no significant difference in EFS (HR for BR, 0.84; 95%CI, 0.46-1.53; P=.56; Fig. C) or OS (HR, 0.92; 95%CI, 0.46-1.83; P=.80). Results for toxicities and costs were again consistent. Conclusions: Among older patients with SMZL and NMZL treated in the community, the use of first-line BR is increasing. However, in this large observational study, BR was not associated with any significant EFS or OS benefit over single-agent R, while it increased toxicities and costs. Without a formal randomized histology-specific study, single-agent R may offer a favorable risk/benefit ratio as a first-line therapy for older NMZL/SMZL patients at average risk, reserving BR for those with compelling clinical circumstances. Our results may however be affected by bias due to unobserved confounding, and may not be applicable to younger patients. Disclosures Olszewski: Adaptive Biotechnologies: Research Funding; Genentech: Research Funding; TG Therapeutics: Research Funding; Spectrum Pharmaceuticals: Research Funding. OffLabel Disclosure: Rituximab with bendamustine is off-label for marginal zone lymphoma

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Population Based Analysis of Mantle Cell Lymphoma in Texas: Are Outcomes Any Different in Hispanics?

Blood ◽

10.1182/blood-2020-137737 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 18-19

Author(s):

Michael M. Song ◽

Abhishek Pandya ◽

K Tai Lucero ◽

James J Yoo ◽

Joel E Michalek ◽

...

Keyword(s):

Mantle Cell Lymphoma ◽

Combination Chemotherapy ◽

Survival Probability ◽

Research Funding ◽

Cell Lymphoma ◽

Poverty Index ◽

Recommended Treatment ◽

Significant Difference ◽

Mantle Cell ◽

Stage 1

Introduction: Mantle cell lymphoma (MCL) is a rare type of incurable B-cell lymphoma with an incidence rate of ~0.8/100,000 in the United States (US) (Blood, PMID: 30154113; CA Cancer J Clin, PMID: 27618563). Recent advances in understanding of MCL biology, development of new therapeutic modalities such as Bruton tyrosine kinsase inhibitors (BTKi), and advancement of treatment strategy incorporating chemotherapy and non-chemotherapy treatment modalities have improved survival (Am J Hematol, PMID: 30963600; Blood, PMID: 26059948; Blood, PMID: 28899853). However, prognosis for MCL remains poor overall (Blood, PMID: 30154113). Although variations in incidence in MCL by race has been reported in the literature (CA Cancer J Clin, PMID: 27618563), there is currently limited data available on differences in demographics, treatment patterns, and outcomes in Hispanic (H) MCL patients. Methods: In this retrospective cohort study, de-identified data was obtained from the Texas Cancer Registry (TCR) database for those diagnosed with MCL between 2006-2016. Standard demographic variables collected include gender, race, ethnicity, birthplace, dates at diagnosis and death, primary payer at diagnosis, stage, type of treatment, poverty index, and vitality status among others. The significance of variation in the distribution of outcomes with ethnicity [H, non-Hispanic (NH)] was assessed with Fisher's Exact test, Pearson's Chi-square test, T-test, or Wilcoxon test as appropriate. Survival time was measured in years from date of primary diagnosis to date of death. Patients not coded as dead were considered censored on survival time at the date last seen. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. All statistical testing was two-sided with a significance level of 0.05. Results: A total of 1852 (296 H, 1556 NH) patients were included in the final analysis. Median age at diagnosis were 65.5 (H) and 68.0 (NH). 72.6% of H and 72.7% of NH cohorts were male. Of the NH cohort, 92.5% were White, 5.3% Black, 1.5% Asian, 0.4% Native American and 0.1% with unknown race. There was a statistically significant difference between the cohorts in the poverty index. Most H (50.5%) were in the 20-100% bracket, while the majority of NH (36.2%) were in the 10-19.9%. The majority of the cohort were from metro areas (90.2% H and 82.6% NH) and non-border counties (72.6% H and 97.2% NH). There was a statistically significant difference in insurance status at diagnosis between the cohorts. Medicare was the most common type for both H (41.1%) and NH (50.2%), while 13.4% of H and 4.0% of NH were uninsured. The majority of H (66.2%) and NH (64.0%) were diagnosed with stages 3-4 MCL; for H, stage 1 10.5%, stage 2 6.1%, stages 3-4 66.2%; for NH, stage 1 10.4%, stage 2 6.6%, stages 3-4 64.0%. The most common treatment received was combination chemotherapy (43.2% H, 38.8% NH); for H, combination chemotherapy (CC) 43.2%, single agent chemotherapy (SAC) 7.4%, chemotherapy not otherwise specified (CNOS) 14.5%, died prior to recommended treatment (PRI) 1%, refused recommended treatment (REF) 0.7%, treatment recommended but not given (NG) 0.3%, treatment contraindicated (CI) 0.7%, no treatment (NT) 18.6% and unknown treatment status (UTS) 13.5%; for NH, CC 38.8%, SAC 10.5%, CNOS 14.5%, PRI 0.2%, REF 1.3%, NG 0.3%, CI 0.8%, NT 23.0% and UTS 10.4%. Regarding BMT/stem cell infusion, 3.1% H and 3.6 NH were confirmed to have received it; 2.5% H and 2.1% NH were confirmed to have received treatment involving radiation. Median survival was 3.7 years (y) and 3.8 y for H and NH respectively; the survival probability at 2 y was 0.65 (0.59-0.71) vs 0.65 (0.62-0.68), 5 y 0.40 (0.33-0.48) vs 0.41 (0.38-0.44) and 10 y 0.19 (0.12-0.30) vs 0.14 (0.09-0.21) for H and NH respectively. There was no statistically significant differences between the cohorts on stage of disease at diagnosis, types of treatment received or overall survival probability. Conclusions: In Texas residents diagnosed with mantle cell lymphoma between 2006-2016, there were statistically significant differences in the level of poverty and insurance coverage between H and NH cohorts but no differences in stage at diagnosis, type of treatment received, or survival. Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

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Survival Impact of Patients (Pts) with Chronic Myeloid Leukemia (CML) Due to Failure from the Use of One or More Tyrosine Kinase Inhibitors (TKI)

Blood ◽

10.1182/blood.v126.23.1587.1587 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1587-1587 ◽

Cited By ~ 3

Author(s):

Mary Akosile ◽

Sherry Pierce ◽

Mark Brandt ◽

Srdan Verstovsek ◽

Gautam Borthakur ◽

...

Keyword(s):

Overall Survival ◽

Median Survival ◽

Survival Probability ◽

Research Funding ◽

Treatment Options ◽

Chronic Phase ◽

Response To Therapy ◽

Free Survival ◽

The Impact

Abstract Background: Imatinib induces durable complete cytogenetic remissions (CCyR) in at least two thirds of pts with chronic phase (CP) CML, most of them also achieving a major molecular response (MMR). However, some pts become intolerant or resistant to imatinib and require change of therapy to a 2nd or 3rd generation TKIs (dasatinib, nilotinib, bosutinib, and/or ponatinib). The projected 3-year survival for these pts was reported as 72% (Kantarjian et al. Cancer 2007) at a time when treatment options for such pts was limited. A smaller subset of pts may require additional changes to a third or fourth TKI. The impact of sequential TKI therapy, although standard practice, has not been well studied. We analyzed the long term outcome of pts receiving multiple TKIs. Method: We analyzed the medical records of 1775 pts with CML-CP treated at a single institution between 02/2000 and 07/2015. Among them 582 (33%) received more than one TKI as follows: 2TKIs (n=370), 3TKIs (n=130), and 4+TKIs (n=82; 4 TKI n=59, 5 TKI n=20, 6 TKI n=1, 7 TKI n=2). For the purpose of this analysis, a TKI used more than once was counted as 2 TKI provided there was a different TKI used between the two periods when the TKI in question was used. We analyzed pt's characteristics, response to therapy, transformation to accelerated and blast phase, and long term outcomes. Overall Survival (OS) and Transformation-Free Survival (TFS) probabilities were measured using Kaplan-Meier method starting from the date they began to use the their 2nd TKI and grouped by the number of TKI used. Results: The number of CML pts in early CP (diagnosis to start of therapy, ≤ 12 months) that used 2, 3, and 4+TKIs was 229, 54, and 34, respectively. The number of pts in late CP (diagnosis to start of therapy >12 months) that used 2, 3, and 4+TKIs was 141, 76 and 48 respectively. The median age (range) for pts that used 2, 3, and 4+ TKIs were 48 yrs (15-81), 52 yrs (18-87), and 53 yrs (18-80), respectively. The ratio of males to females in each cohort was 187:183, 58:72, and 37:45, respectively. The median time from diagnosis to 2nd, 3rd and 4th TKI was 2, 4, and 6 years respectively. For the 3 cohorts (2, 3, 4+TKIs), TKIs used included imatinib (n=322, n=130, n=79), dasatinib (n=227, n=112, n=77), nilotinib (n=119, n=109, n=70), ponatinib (n=44, n=27, n=37) and bosutinib (n=26, n=13, n=29), respectively. The 3-year overall survival probability for pts treated with 2 TKI was 88% (median survival not reached); for those that used 3 TKI 72% (median survival not reached), and for those that used 4+ TKI 48% (median survival 34 months) (Fig. 1). Corresponding 5-year figures are 80%, 53% and 38%. The 3-year transformation-free survival probability for pts treated with 2 TKI was 93%; for those treated with 3 TKI 88%; and for pts treated with 4 TKI 80% (median not reached in any cohort ) (Fig. 2). Corresponding figures for 5-years are 90%, 84%, and 75%. Conclusion: With more and improved treatment options, pts with resistance or intolerance to multiple TKI have the potential for long-term survival. Nearly 80% of pts who receive 2 TKI are alive at 5 years and more than 90% remain in chronic phase. As pts experience subsequent failure, the outcome worsens. These results provide information that may help with treatment planning and set the expectations against which treatment options used in such pts should be measured. Figure 1. Overall Survival Probability Figure 1. Overall Survival Probability Figure 2. Transformation-Free Survival Probability Figure 2. Transformation-Free Survival Probability Disclosures Wierda: Glaxo-Smith-Kline Inc.: Research Funding; Celgene Corp.: Consultancy. Daver:ImmunoGen: Other: clinical trial, Research Funding. Burger:Pharmacyclics LLC, an AbbVie Company: Research Funding. Pemmaraju:Stemline: Research Funding; Incyte: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Research Funding; LFB: Consultancy, Honoraria. Cortes:Novartis: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; BerGenBio AS: Research Funding; BMS: Consultancy, Research Funding; Teva: Research Funding; Ariad: Consultancy, Research Funding; Astellas: Consultancy, Research Funding; Ambit: Consultancy, Research Funding; Arog: Research Funding; Celator: Research Funding; Jenssen: Consultancy.

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