Is There a Disparity in Oncological Outcomes for Hispanics? Analysis of Burkitt Lymphoma

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 45-46
Author(s):  
Carolina Velez-Mejia ◽  
Daniela Hernandez ◽  
Joel E Michalek ◽  
Qianqian Liu ◽  
Adolfo Enrique Diaz Duque
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
Survival Probability ◽  
Burkitt Lymphoma ◽  
Research Funding ◽  
Statistical Testing ◽  
Statistical Computing ◽  
P Value ◽  
Oncological Outcomes ◽  
The Us

Background Burkitt lymphoma (BL) is a rare but highly aggressive B cell neoplasm, with treatment success rates exceeding 80% in the United States (US) (Blood, PMC:3682339). Although there are different presentations of BL, the treatment and prognosis are quite similar among them (Blood, PMID:15265787). Trends in outcomes of BL have been previously reported, however, sub-analysis for minorities like Hispanics (HI), have not been widely studied. Understanding ethnic disparities in outcomes and patterns of care are crucial given the growth of HI in the US (APMIS, PMID:23607450). There is an unmet need in this field; therefore, this population-based study aims to help understand the impact of ethnicity in clinical outcomes for BL. Material and Methods A retrospective analysis of patients diagnosed with BL recorded in the Texas Cancer Registry was carried out. Inclusion criteria was histopathologic proven BL using the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. Patients were divided in HI and non-Hispanics (NH) for comparison. Key demographic, socioeconomic, clinical, and survival outcome 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 analysis was calculated in years from date of primary diagnosis to date of death or last date of follow up. 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%. 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 From 2006-2016, 896 patients (HI: n=275, NH: n=621) were diagnosed with BL. The median age at diagnosis for HI was 41 years vs 44 for NH [p-value 0.05]. Male sex predominated for HI and NH. Origin for HI was mainly Spain, Mexico and Central/South America. Both HI and NH were mainly identified as white; other races included black, asian and Native American [p-value <0.001]. For HI, the bracket of poverty indicator that prevailed was 20-100%; while majority of NH were in 10-19.99% [p-value <0.001]. There was a statistical significance regarding the primary payer at diagnosis [p-value <0.001]. HI had a similar distribution among private insurance (PI), Medicaid, Medicare and not insured/self-pay; while NH had primarily PI. The greatest proportion of HI and NH where located in the metropolitan, non-border area. The majority of HI and NH were diagnosed at stage III-IV [p-value 0.459]. Treatment at diagnosis showed a similar pattern for HI and NH, choosing mainly chemotherapy. For both groups, most of the patients did not undergo transplant or radiation (Figure1A). The median survival time for HI was 4.2 years and for NH was 7.0 years. Survival probability at 2, 5 and 10 years for HI was 0.53 (CI=0.467,0.599), 0.50 (CI=0.484,0.573) and 0.33 (CI=0.213,0.515), respectively. For NH it was 0.60 (CI=0.568,0.65), 0.53 (CI=0.385,0.506) and 0.44 (0.385,0.506), respectively (Figure1B). The overall survival probability at 10 years did not show a statistically significant difference for HI vs NH [p-value 0.12] (Figure1C). Conclusions Survival analysis at 10 years shows similar outcomes for HI vs NH; however, significant differences were observed in demographics and sociocultural variables. HI were diagnosed at a younger age, predominantly of Spanish origin and white race. More HI were uninsured compared to NH, as well as their poverty index was statistically higher. The fact that no variation was reported in overall survival may be explained by the use of standardized treatment. From our analysis, racial or economical variations do not seem to affect oncological outcomes in BL for HI in the US. 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.

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

Blood ◽  
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.

The Role of Ethnicity in Hepatosplenic T-Cell Lymphoma: A Retrospective Survival Analysis in Texas

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 19-19
Author(s):  
Leyla Bojanini Molina ◽  
Joel E Michalek ◽  
Qianqian Liu ◽  
Adolfo Enrique Diaz Duque
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
Survival Probability ◽  
Research Funding ◽  
Clinical Characteristics ◽  
Median Overall Survival ◽  
Cell Lymphoma ◽  
Statistical Computing ◽  
P Value ◽  
Hepatosplenic T Cell Lymphoma

Background Hepatosplenic T-Cell lymphoma (HSTCL) is an aggressive type of lymphoma with extremely low incidence. It has a high fatality rate with a 5-year overall survival (OS) of <10% (Am J Surg Pathol, PMID: 26872013). Although there is no therapy that has proven to produce sustained remission, recent studies suggest improvement in outcomes with allogeneic stem cell transplant (allo-SCT) (Leukemia, PMID: 25234166). Clinical characteristics and therapeutic outcomes have been previously reported; however, documentation of outcomes in minorities such as Hispanics (HI) are lacking. Given the growth of the HI population in the US it is imperative to understand the difference in outcomes and patterns of care (CA Cancer J Clin, PMID: 30285281). The present study aims to fill this gap in the literature; therefore, the present population-based study evaluates the impact of ethnicity in clinical outcomes for HSTCL. Material and Methods We retrospectively searched for cases of HSTCL recorded in the Texas Cancer Registry. Inclusion criteria included and established pathologic diagnosis of HSTCL using the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. Patients were divided between HI and non-Hispanics (NH). Demographic, socioeconomic, clinical and survival outcomes were recorded. Statistical analysis included Fisher's Exact test, Pearson's Chi-square test, T-test or Wilcoxon test. Survival analysis was calculation in years from date of primary diagnosis to date of death or last date of follow up. Survival distributions were described with Kaplan-Meier curves, and long rank testing was used to assess significance of variation in median survival with ethnicity. All statistical testing was two-sided with a significance level of 5%. 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 From 2006-2016, a total of 25 patients were diagnosed with HSTCL; 23 (92%) were NH and 2 (7%) were HI [<0.0001]. The median age at diagnosis was 46 for HI and 48 for NH. It was predominantly seen in males for both HI and NH. The patients mostly self-identified as white (HI: n=2, Nh: n=16), and there were 7 (30%) NH patients that self-identified as black. For HI, one patient was in the bracket of poverty indicator of 10-19.9% and the other one was in the 20-100%; for the NH patients the bracket that prevailed was 10-19.9% [p-value 0.56]. Both HI patients had private insurance (PI); insurance status on NH patients included 7 (33.3%) with PI, 5 (23.8%) with Medicare, and 7 (33.3%) was unknown [p-value 0.64]. The majority of HI and NH patients were located in the metropolitan, non-border area. Stage at diagnosis for NH was mostly III-IV; one HI had a stage III-IV HSTCL and the other was unstaged [p-value 1.0]. From a therapeutic standpoint, the majority of HI and NH patients received chemotherapy, with 13 patients (HI: n=2, NH: n=11) receiving multiple agents as first-line therapy [p-value 0.84]. From the two groups, only 3 (13%) NH patients underwent allo-SCT [p-value 0.014]. The majority of HI and NH did not undergo radiation (Figure 1A). The median overall survival was 0.5 years in HI and 0.6 in NH. The survival probability at 2 years for HI and NH was 0.5 (CI=0.16, 1) and 0.29 (CI=0.15, 0.56) respectively; at 5 years for HI was 0.5 (CI 0.16, 1) and for NH was 0.23 (CI=0.10, 0.51) (Figure 1B). The overall survival probability at 10 years was not statistically different for HI vs NH [p-value 0.53] (Figure 1C). Conclusions Survival analysis shows that HSTCL is usually fatal with a median overall survival of less than a year, and no difference in survival probability at 10 years for both HI and NH. The majority of patients in our study were non-Hispanic white males. A significant finding was that NH patients had access to allo-SCT as opposed to the HI patients. No statistically significant difference in survival was noted depending on the insurance or poverty levels. No other demographics or sociocultural variables seemed to have an impact in outcomes. The main limitation of our study is our sample size that limits generalizability and power of our statistical analysis. Further studies using multiple cancer registries are warranted to assess the clinical characteristics and survival outcomes in HI with HSTCL. 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.

scholarly journals Ethnicity Matters When Comparing Overall Survival for Patients Diagnosed with Follicular Lymphoma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1356-1356
Author(s):  
Carolina Velez-Mejia ◽  
Rodolfo Garza Morales ◽  
Qianqian Liu ◽  
Joel E Michalek ◽  
Adolfo Enrique Diaz Duque
Keyword(s):  
Overall Survival ◽  
Follicular Lymphoma ◽  
Survival Probability ◽  
Research Funding ◽  
Median Overall Survival ◽  
Population Based ◽  
Statistical Testing ◽  
Wilcoxon Test ◽  
P Value ◽  
Population Based Study

Abstract Background Follicular lymphoma (FLy) is one of the most common subtypes of Non-Hodgkin Lymphomas (NHL) (Cancer EpidemiolPMC4323749). In prior studies, better progression-free survival has been noted in Hispanics (HI), however, further characterization of this ethnic minority needs to be addressed (Ann Lymphoma PMC5877479). This result is consistent with previous research explaining the development of NHL as an heterogeneous process where unique outcomes for races have been noted (Cancer PMID: 22434428). This is the first combined statewide population-based study of Texas (TX) and Florida (FL) evaluating ethnic differences for HI vs Non-Hispanics (NH) comparingdemographics, socioeconomic, clinical and survival patterns of patients diagnosed with FLy. The value of using these states relies on the fact that the percentage of HI in TX and FL are 39.7% and 26.4%, respectively (US Census 2020). Material and Methods This is a retrospective analysis of patients diagnosed with FLy recorded in the Texas Cancer Registry and the Florida Cancer Data System from 2006-2017. Inclusion criteria was histopathologic proven FLy. 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. Results From 2006-2017, 20,497 patients (HI n=3,176, NH n=17,321) were diagnosed with FLy (Table 1, Table 3). In TX, the median age at diagnosis for HI was 60 years (y) vs 64 y for NH [p-value <0.001]. In FL, it was 62 y and 67 y, respectively [p-value <0.001]. In both states, female sex predominated for HI and NH. In TX, the bracket of poverty index that prevailed for HI was 20-100% while for NH was 10-19.9% [p-value <0.001]. In FL, the largest number of HI and NH were in the 10-19.9% bracket [p-value <0.001]. In TX, both HI and NH were more likely be with government-sponsor insurance, however, up to 15% of HI did not have insurance vs 4% in NH [p-value <0.001]. This was also the case in FL, however their number of uninsurance corresponded to 6% and 2% respectively. In TX, the largest number of HI and NH patients were diagnosed at stage III-IV with 49% and 42% respectively [p-value <0.001]. In FL, for these stages it corresponded to 43% and 37% for HI and NH [p-value <0.001]. In TX, treatment at diagnosis showed a similar pattern for HI and NH, choosing mainly no treatment followed by multiple chemotherapy agents [p-value <0.001]. In FL, this trend was also seen. In both states and for HI and NH, most of the patients did not undergo transplant or radiation. In TX, the median overall survival for HI was 9.2 y vs 8.6 y for NH; the survival probability at 2, 5 and 10 y for HI corresponded to 0.835, 0.701 and 0.453, while for NH it was 0.850, 0.703 and 0.354, respectively; and the overall survival probability at 10 y had no statistically significant difference [p-value 0.44] (Table 2, Graph 1). In FL, the median overall survival for HI was not reached vs NH at 10.1 y; the survival probability for HI at 2, 5 and 10 y was 0.871, 0.777 and 0.601, while for NH it was 0.845, 0.709 and 0.506, respectively; and the overall survival probability at 10 y was statistically significant [p-value <0.0001] (Table 4, Graph 2). Conclusions This large two statewide population-based study identified statistical differences in oncological outcomes comparing HI and NH in patients diagnosed with FLy. HI diagnosed with FLy have higher survival at 10 y, and this difference was statistically significant in FL. Moreover, statistical significance was noted in demographic, sociodemographic and disease characteristics. Additional research should be carried out to identify the variables that drive this difference since advance stage, lack of insurance or treatment at diagnosis do not seem to be influencing it. There may be a combination of lifestyle factors (alcohol, cigarette, diet, other), occupational hazards, autoimmune diseases or protective mechanisms, infectious diseases exposures and unique epigenetic interactions that may explain why HI live longer when diagnosed with FLy. Figure 1 Figure 1. Disclosures Diaz Duque: Incyte: Consultancy; Morphosys: Speakers Bureau; Astra Zeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Epizyme: Consultancy; ADCT: Consultancy.

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

Blood ◽  
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.

Balancing Acute Graft Versus Host Disease (aGVHD) and Survival after Peripheral Allogeneic Stem Cell Transplantation (SCT) in Hematological Malignancies: A Potential for Graft Engineering.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3285-3285
Author(s):  
Ayman Saad ◽  
Mohammed Almubarak ◽  
Abraham Kanate ◽  
Aaron Cumpston ◽  
Kathy Watkins ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cells ◽  
Stem Cell ◽  
Survival Analysis ◽  
Acute Gvhd ◽  
Hematological Malignancy ◽  
P Value ◽  
Cell Dose ◽  
Cd8 Cell

Abstract Purpose: Peripheral allogeneic SCT is used to treat different types of hematologic malignancies. The target CD34 stem cell dose is 2 -5 x 106/Kg. The dose of CD3+ cells in the infusate is not taken into account except in T-depleted transplant. T-cell dose in peripheral blood stem cell collections is at least 10-fold more than that in a bone marrow harvest. Regulatory T cells (CD4+, CD25+), which comprises 5–10% of CD4 + T cells have been correlated with less incidence of aGVHD. In our study we are trying to determine the impact of T-cell dosing on the overall survival and incidence of aGVHD after peripheral allogeneic SCT in a group of patients with hematological malignancy. Methods: A retrospective study of 66 consecutive patients who underwent peripheral allogeneic SCT for hematological malignancy in our institution between January 2003 and April 2006. The median duration of follow up after SCT was 12.6 months (range 0.2–53). Duration of follow up was compromised only in a subset of patients who had early mortality following SCT. Proportional hazard model was used to define the cutoff value of CD3, CD4, and CD8 cell dose that separate 2 groups of patients with highest statistically significant difference in terms of incidence of aGVHD. Kaplan-Meier Survival Analysis was used for correlate the overall survival (calculated from date of transplant) among these groups subdivided in terms of CD3, CD4, and CD8 cell doses. Results: The 66 patients (6 females, and 60 males) with median age of 48 years (range: 19–63 years) had different malignancies; 6 ALL, 34 AML, 1 biphenotypic leukemia, 1 CLL, 11 CML, 5 Hodgkin lymphoma, 8 NHL. The SCT was from matched related donors in 39 patients, and from matched unrelated donors in 27 patients. The incidence of aGVHD (grade 2–4) was statistically significantly less among those who received CD3 dose < 33.5 × 107/kg IBW (P value: 0.04), tended to be less among those who received CD4 dose < 32.6 × 107/kg IBW (P value: 0.06), and was statistically significantly less among those who received CD8 dose < 6.2 × 107/kg IBW (P value: 0.04). Survival analysis showed no statistically significantly difference in the overall survival (OS) among all patients groups. Median OS was 10.5 months for those who received CD3 dose ≤ 33.5 ×107/kg IBW and 17 months for those who received > 33.5 ×107/kg IBW (P value: 0.35). Median OS was 12 months for those who received CD4 dose ≤ 32.6 ×107/kg IBW and 16.3 months for those who received > 32.6 ×107/kg IBW (P value: 0.8). Median OS was 6 months for those who received CD8 dose ≤ 6.2 ×107/kg IBW and 14.4 months for those who received > 6.2 ×107/kg IBW (P value: 0.13). Conclusions: In our series, CD3 dose less than 33.5 ×107/kg IBW and CD8 dose less than 6.2 ×107/kg IBW were associated with statistically significant reduced risk of grade 2–4 acute GVHD following peripheral allogeneic SCT. Overall survival was not statistically different among these groups of patients. These data suggest that, in addition to considering CD34 dose required for engraftment in allogeneic transplant, the CD3 dose and its subsets CD8 and CD4 may need to be considered to try to minimize the risk of acute GVHD without compromising survival after transplant.

Cladribine in Combination with Standard Daunorubicine and Cytarabine (DAC) as a Remission Induction Treatment Improves the Overall Survival in Untreated Adults with AML Aged < 60 y Contrary to Combination Including Fludarabine (DAF): A Multicenter, Randomized, Phase III PALG AML 1/2004 DAC/DAF/DA Study in 673 Patients-A Final Update.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2055-2055
Author(s):  
Jerzy Holowiecki ◽  
Sebastian Grosicki ◽  
Slawomira Kyrcz-Krzemien ◽  
Kazimierz Kuliczkowski ◽  
Aleksander B Skotnicki ◽  
...  
Keyword(s):  
Overall Survival ◽  
Research Funding ◽  
Remission Rate ◽  
Randomized Study ◽  
Phase Iii ◽  
Remission Induction ◽  
Induction Treatment ◽  
P Value ◽  
Who Grade ◽  
Free Survival

Abstract Abstract 2055 Poster Board II-32 This trial is a continuation of earlier Polish Adult Leukemia Group (PALG) studies on the use of purine analogues for therapy of AML patients (Leukemia 2004,18:989–97, updated at 7 y: ASH 2006, Abstr.N#2003, Ann Hematol. 2008, 87:361–7). The goal of the present study was to evaluate the efficacy of combination including fludarabine – DAF (daunorubicine 60 mg/m2/d iv, d 1–3; cytarabine (AraC) 200 mg/m2/d ci, d 1–7, and fludarabine 25 mg/m2 iv d 1–5) in untreated adult patients with AML, based on head to head comparison with DAC (DNR, AraC, Cladribine), and standard DA regimens (preliminary results: ASH 2008, abstr.#133). Primary end-points were: complete remission rate (CR) and overall survival (OS); secondary objectives were: toxicity and leukemia-free survival (LFS). Patients achieving CR received two courses of subsequent intensive consolidation: HAM (HD AraC, mitoxantrone) and HD AraC. Reduction of consolidation was accepted in patients treated with early alloBMT. In case of partial remission (PR) after the first induction course the same regimen was repeated. Patients with no remission (NR) or with PR after 2 induction courses were withdrawn from the study. Between 09.2004 and 05.2008, 673 adult untreated AML patients aged 18–60 y, median 47 y, sex: male 49,5%, female 50,5%, treated in 18 co-operating PALG centers were centrally randomized to either DAF (n=225), DAC (n=224) or DA (n=224) arm (1:1:1). PML/RAR alfa positive - FAB M3 cases were excluded. The study groups were well balanced in respect of age, sex, FAB subtype, and WBC. The results are summarized in the table. Outcome DAC (n = 223) DAF (n = 219) DA (n = 210) P Value (DAC vs DA) P Value (DAC vs DAF) CR 68 59 56 .013 .08 CR after 1 cycle 62 55 50,5 .017 16 3-yr OS 46 30 31 02 .02 2-yr LFS 47 40 39 NS NS Both, the entire CR rate and the CR rate after a single induction course were significantly superior in the DAC arm if compared with DA and DAF subgroups. With a median follow-up of 34 months (the longest observation time 5y) the OS rate equaled 46% for the DAC treated subgroup and was higher in comparison to the standard DA arm and the DAF arm. There were no significant differences in the leukemia free survival rates. The early death rates of 8,5–11%. were similar in the studied treatment subgroups. All patients developed WHO grade IV thrombocytopenia and agranulocytosis. The frequency and severity of infections, mucositis, vomiting, diarrhoea, alopecia, polyneuropathy as well as of cardiac, liver or kidney dysfunctions were comparable in particular arms. In conclusion, this updated results of randomized study prove that the incorporation of cladribine to the standard DA induction regimen (DAC) improves CR rate and the overall survival in adults with AML aged up to 60 y, without additional toxicity. This beneficial effect was not observed in patients treated using the DAF protocol with fludarabine added to the standard “DA 3+7” schedule. Disclosures: Robak: Celgene: Consultancy; Roche: Honoraria, Research Funding; Genmab: Research Funding; Cambridge Antibody Technology: Research Funding; GlaxoSmithKline: Honoraria. Warzocha:BMS: Consultancy, Honoraria; Celgene: Consultancy; Roche: Honoraria; Pfizer: Honoraria; Amgen: Honoraria.

Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia In Patients up to Age 75: Comparison of Survival In Patients with An Available Donor Compared to Patients without a Donor

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2381-2381
Author(s):  
Teresa Field ◽  
Janelle Perkins ◽  
Taiga Nishihori ◽  
Joseph Pidala ◽  
Hugo F. Fernandez ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
Myelodysplastic Syndrome ◽  
Cell Transplantation ◽  
Research Funding ◽  
Chronic Myelomonocytic Leukemia ◽  
No Donor ◽  
Hematopoietic Stem ◽  
Myelomonocytic Leukemia

Abstract Abstract 2381 Allogeneic hematopoietic cell transplantation (HCT) remains the only curative treatment strategy for patients with Myelodysplastic Syndrome (MDS) or Chronic Myelomonocytic Leukemia (CMML). Recent reduction of the transplant related toxicity has permitted the expansion of empiric age limitations for HCT up to 75 years. There has been limited comparative data on HCT focusing on donor availability in patients with MDS/CMML. Between January 2004 and September 2009, a total of 255 new patients (NP) with a diagnosis of MDS or CMML were evaluated for HCT at Moffitt Cancer Center. This report describes the outcomes of these patients with emphasis on donor availability. Donor Search Results: Of the 255 NP, 58 did not undergo a donor search. Reasons for not proceeding were as follows: Medicare declined coverage due to age >65 (18), waiting as have low risk disease (15), patient declined (6), patient seen as second opinion only (7) and patient was not eligible for HCT (12). These patients were not included in the survival analysis. Of the 197 patients who had a donor search initiated, a sibling (SIB) matched unrelated (MUD) or single HLA antigen/allele mismatch (mMUD) unrelated adult donor was found in 173 patients. A suitable adult donor was not identified in the remaining 24 patients. To mitigate bias due to factors giving a survival advantage to patients who were stable enough to survive the donor and proceed to HCT, the survival analysis included only those patients alive 90 days after the donor search was initiated. We have been able to identify donors within this time frame for 99% of the patients who ever found one, although time to transplant is longer. At the 90 days landmark, there were 164 patient in the Donor cohort, and 19 patients in the No Donor cohort. Donor Cohort: The median age was 56.6 yrs (18.5 – 73.5). Ninety-seven patients (59%) were older than 55 yrs and 26 (16%) were above 65 yrs. At the time of the transplant consult, IPSS risk was Low (10), Int-1 (44), Int-2 (48), High (25), AML (21), CMML (13), or not evaluable (NE) (3). Donors included SIB (60), MUD (75) and mMUD (29). Median follow-up of surviving patients is 27.7months (7.2 – 70.7). No Donor Cohort: Median age was 57.4 yrs (32.6 – 68.1) with 12 patients (63%) older than 55 yrs and 3 (16%) patients older than 65 years of age. IPSS at initiation of the donor search was Int-1 (5), Int-2 (6), High (5), AML (1) and CMML (2). Median follow-up is 9.2 months (1.4 – 61.5). Of the 19 patients with no donor, 3 patients received an umbilical cord blood HCT elsewhere and were analyzed by intent to treat. Outcomes: Patients with a donor had significantly improved overall survival from time of donor search vs. patients with no donor (P=0.007) with 2 year OS of 48% vs. 23%, respectively. Median survival for the donor group was 22.2 months [95% CI 14.7 – 35.7] vs. 10.1 months for those without a donor [95% CI 2.3 – 14.7]. Transplant: Of the 164 patients with a donor, 121 (74%) patients received the planned allogenic transplants. The 2-year overall survival (OS) after transplantation is similar for SIB (51%), MUD (39%) or mMUD (68%) transplant recipients (P=0.4), and also similar by age below or above 55 years (P=0.7). These data demonstrate that most patients with MDS or CMML can have a suitable donor identified and proceed to HCT. Overall survival is significantly improved for those patients who have a suitable sibling or unrelated donor. Disclosures: Lancet: Eisai: Consultancy; Celgene: Honoraria. Alsina: Millenium: Consultancy, Research Funding; Celgene: Research Funding; Novartis: Consultancy. List: Celgene: Research Funding.

scholarly journals Effect of Timing and Duration of Maintenance Lenalidomide in Myeloma Patients after Autologous Stem Cell Transplantations

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 194-194
Author(s):  
Idrees Mian ◽  
Denai Milton ◽  
Uday R. Popat ◽  
Nina Shah ◽  
Yago Nieto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Maintenance Therapy ◽  
Research Funding ◽  
Maintenance Treatment ◽  
Progression Free Survival ◽  
Disease Status ◽  
Hazard Ratio ◽  
P Value ◽  
Free Survival ◽  
Late Initiation

Abstract Introduction: Maintenance lenalidomide after autologous hematopoietic stem cell transplantation (auto HCT) has been shown to improve progression free (PFS) and overall survival (OS) in myeloma patients. In this analysis we sought to determine the impact of lenalidomide treatment on achievement of complete remission (CR), survival and the incidence of secondary primary malignancies (SPM). Methods: We retrospectively analyzed all (N=466) consecutive myeloma patients who underwent auto HCT and received maintenance lenalidomide between August 2006 and September 2013 at our institution. Patients received doses of maintenance lenalidomide ranging from 5 mg – 15 mg/day or every other day. We looked at whether lenalidomide improved disease status, specifically CR in patients who had not achieved this before maintenance initiation and the median time to achieve CR. We also analyzed the effects of early initiation (<4-months after auto HCT) of maintenance lenalidomide versus late initiation (≥ 4-months after auto HCT) with regards to PFS and OS using the Kaplan-Meier method. Lastly we assessed if continuation of maintenance therapy beyond 2 and 3-years after auto HCT improved PFS and OS and increased the incidence of SPM. Results: The median follow-up time for all patients was 26.6 months. 173 patients (37%) experienced improvements in their disease status. Of these, 86 patients (50% of those with noted improvements and 19% of total patients assessed) who were not in CR before maintenance achieved CR while on maintenance. The average time to achieve CR in these patients was 12.9 months. Comparing the patients who were started on early maintenance treatment with those who were started on late maintenance therapy, we did not find any difference with regards to PFS (Hazard Ratio [HR]=0.90; p-value=0.57) and OS (HR=0.90; p-value=0.74). However, patients who had been on lenalidomide for > 2 years experienced a significant benefit in OS compared with those on lenalidomide for ≤ 2 years (HR=0.36; p-value=0.0015), although no difference in PFS was observed between the two cohorts (HR=0.77; p-value=0.18). A similar trend in OS was seen for patients who had been on lenalidomide > 3 years compared with those on maintenance treatment ≤ 3 years, though not statistically significant (HR=0.47; p-value=0.10). Again, no difference in PFS was noted between the two groups. Lastly there were only 12 cases of SPM reported in all patients assessed with no statistically significant association to the duration of lenalidomide use. In all 12 cases, lenalidomide was suspended and the mortality among these patients was 50%. Conclusions: Maintenance lenalidomide improves response rates after auto HCT in some patients including the CR rate, however, the median time to achieve CR in these patients is approximately 13 months. The patients who received maintenance therapy for > 2years had a significantly lower risk of death with a trend of improved OS in patients who continued maintenance therapy beyond 3-years. We conclude that the maintenance therapy should be continued for at least 2 years and possibly longer after auto HCT. Table 1 Summary of Survival Outcomes Maintenance Treatment Initiation Measure Early (N=155) Late (N=184) p-value Progression-free survival Hazard ratio (95% CI)a 0.90 (0.63, 1.30) 0.57 Overall survival Hazard ratio (95% CI)a 0.90 (0.49, 1.66) 0.74 Duration of Maintenance Treatment Measure > 2 years (N=115) ≤ 2 years (N=224) p-value Progression-free survival Hazard ratio (95% CI)b 0.77 (0.52, 1.13) 0.18 Overall survival Hazard ratio (95% CI)b 0.36 (0.19, 0.67) 0.0015 > 3 years (N=49) ≤ 3 years (N=290) p-value Progression-free survival Hazard ratio (95% CI)b 0.75 (0.45, 1.26) 0.28 Overall survival Hazard ratio (95% CI)b 0.47 (0.19, 1.15) 0.10 a Cox proportional hazards regression model: measure included as a baseline covariate with the following additional covariates: patient’s cytogenetic risk, creatinine, hemoglobin, B2-microglobulin, ISS stage at diagnosis, disease status at auto HCT, and response prior to auto HCT. b Cox proportional hazards regression model: measure included as a time-dependent covariate with the covariates listed above. Figure 1 Comparison of Overall Survival in Early vs Late initiation of Revlimid Figure 1. Comparison of Overall Survival in Early vs Late initiation of Revlimid Figure 2 Overall Survival – All Patients Figure 2. Overall Survival – All Patients Disclosures Shah: Novartis: Consultancy, Research Funding; Millennium Pharmaceuticals: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Onyx Pharmaceuticals: Consultancy, Research Funding; Array: Consultancy, Research Funding. Orlowski:Onyx Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

scholarly journals Combining Clinical Features with Genetic Factors Improves Survival Prediction for Adults with Acute Myeloid Leukemia: Validation of a New Score System in 3 Cohorts

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2602-2602
Author(s):  
Douglas R. A. Silveira ◽  
Lynn Quek ◽  
Anna Corby ◽  
Juan L Coelho-Silva ◽  
Diego A Pereira-Martins ◽  
...  
Keyword(s):  
Overall Survival ◽  
Genetic Risk ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Genetic Factors ◽  
P Value ◽  
Survival Prediction ◽  
Training Cohort ◽  
C Statistic ◽  
Acute Myeloid

Introduction: Risk stratification in acute myeloid leukemia (AML) is continually being refined as we learn more about the molecular pathophysiology of this heterogeneous disease. European LeukemiaNet (ELN) 2017 used widely to stratify the 'genetic' risk of AML, but there are considerable challenges in its application, particularly in centres where molecular genetic testing either not available, or not sufficiently timely for clinical decision making. Up to a third of the study subjects cannot be stratified using a full cytogenetic-molecular model in real-time, real-life setting. There are few attempts to combine clinical features and genetic factors aiming to find a scoring system to improve AML survival prediction. There is only one to our knowledge (Sorror ML et al. 2017). This study has generated an Adapted Genetic Risk (AGR) assessment, and used it in combination with clinical risk parameters to create a novel scoring system which has now been validated using two independent cohorts. Methods: A training cohort from São Paulo (FMUSP, n = 167) of intensively treated AML patients (18-65 years) was assessed using ELN2017 genetic criteria. A comparative validation with our AGR which permits missing cytogenetic or molecular data (Figure 1) split these patients into favorable-risk (FR), intermediate-risk (IR), and adverse-risk (AR). This cohort was also used for Cox Proportional-Hazard Model (CPHM) univariate and multivariate analysis to find clinical parameters that would inform a novel Survival AML Score (SAMLS). Variables which are included in SAMLS had to be either significant in both CPHM models or significant in univariate and crucial for multivariate fitness as measured for the Akaike Information Criterion (AIC). We then applied the AGR strategy and SAMLS to 2 independent test cohorts of intensively treated adult AML patients : Riberao Preto (FMRP, n=145) and Oxford (OUH, n=157). The study was approved by the institutional review boards of the 3 participating centers. Informed consent was obtained from all patients according to the Declaration of Helsinki. Results: Table 1 shows the clinical characteristics for all the 3 cohorts. The median follow-up (FUP) was 72.3, 44.4, and 70.5 months for FMUSP, FMRP, and OUH, respectively. The median Overall Survival (OS) was 12.4, 12.5, and 56.4 months and the 5-year OS were 29.6%, 29.7%, and 49.7% respectively. Both ELN2017 and AGR correlated with significant differences in OS (p-value <0.001) and DFS (ELN p=0.002, AGR p=0.003) in the FMUSP cohort. The ROC c-statistic were 0.68 (ELN) and 0.66 (AGR). AGR was validated in FMRP and OUH cohorts, with statistically significant stratification of OS across the 3 risk groups in both cohorts (FMRP p=0.03, OUH p=0.003); and DFS in FMRP (p = 0.04), but not in OUH (p = 0.7)(Table 2 and Figure 2). Multivariate CPHM model for OS in FMUSP which yielded the smallest AIC were: Age, HR 1.52; Albumin, HR 0.50; WBC, HR 1.37; Haemoglobin, HR 1.48; Platelet count, HR 0.64; and AGR-IR, HR 2.23 and AGR-AR HR, 4.66 (Figure 3). Variables which met SAMLS inclusion criteria are in Table 3. SAMLS stratifies AML as low-risk (LR-AML) (SAMS <=1.5) or high-risk (HR AML) (SAMLS >=2) (Table 3 and Figure 4 C-D), where there is a significant difference in survival in the FMUSP training cohort (p <0.001). The 5-year OS was 55% and 9% for LR and HR AML respectively. The ROC c-statistic for OS in FMUSP using SAMLS was 0.80 (21% bigger than using AGR only). SAMLS risk stratification was validated in both FMRP and OUH cohorts for OS (FMRP p-value 0.003, OUH p-value < 0.001) and DFS (p-value 0.04 OUH only). Prediction accuracy was also increased since ROC c-statistic was 0.65 for OS in FMRP (a 10% increase), and 0.77 in OUH (a 22% increase) (Figure 4). Conclusion: ELN2017 genetic risk score for AML was validated in a cohort from a low-medium income country (LMIC). AGR is a proposed risk evaluation that can be used for AML patients for whom fully genetic testing is not feasible (required for ELN2017) and was as accurate as ELN2017. AGR predicts survival in 3 independent cohorts, from LMIC and developed nation settings. When other biological and clinical factors are added to AGR, we were able to show SAMLS is better to predict overall survival than AGR. Importantly, serum Albumin, a simple and routine test parameter, was an independent predictor of OS for AML in all 3 cohorts. Therefore the use of SAMLS can predict early and late mortality and can impact on treatment decisions. Disclosures Quek: Celgene: Research Funding, Speakers Bureau; Agios: Research Funding. Vyas:Astellas: Speakers Bureau; Pfizer: Speakers Bureau; Abbvie: Speakers Bureau; Daiichi Sankyo: Speakers Bureau; Novartis: Research Funding, Speakers Bureau; Forty Seven, Inc.: Research Funding; Celgene: Research Funding, Speakers Bureau.

scholarly journals Survival for Chronic Lymphocytic Leukaemia (CLL) Patients in Hungary from 2000 to 2014 Based on the Single Payer's Database: A Nationwide Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1275-1275
Author(s):  
Maren Gaudig ◽  
István Vályi-Nagy ◽  
Peter Takacs ◽  
Miklos Bacskai ◽  
Petra Kozma ◽  
...  
Keyword(s):  
Health Care ◽  
Overall Survival ◽  
Survival Analysis ◽  
Health Insurance ◽  
Survival Probability ◽  
Outpatient Care ◽  
Lymphocytic Leukaemia ◽  
Kaplan Meier ◽  
Age Cohort ◽  
First Diagnosis

Abstract Background: Real-world evidence based analyses are gaining importance worldwide. They are especially useful to inform medical/scientific evidence setting, health policy decision-making, or health-economic modelling. Due to legislation for data of public interest set in Act LXIII of 2012, health care data recorded by the predominantly state-owned health insurance system are accessible in Hungary. The National Health Insurance Fund Administration (NHIFA) as single payer covers the total population of 10 million inhabitants, providing de-identified patient data on health care resource utilization and demographics upon request. Chronic lymphocytic leukaemia is an adult haematological malignancy. New therapies, e.g. BTKs need to find their place in therapy but the currently available information in Hungary on epidemiology, patient pathways and characteristics on population level are scarce. Aim: During the last decade numerous novel therapeutic options became available. Mortality as an important treatment outcome is of interest to understand any impact these novel agents may have. We evaluated overall survival during the period from 2000 – 2013 with the hypothesis that survival rate is strongly correlated with time of first diagnosis and subsequently availability of appropriate therapies. Methods: As part of a larger project called LYRICS (Lymphoma Real-Life Insight Core Survey) we have conducted a comprehensive retrospective analysis based on the NHIFA's database to map the CLL therapy landscape and outcomes in the last 14 years. The basis of the analysis was the claims database of inpatient and outpatient care (DRG based financing) and outpatient drug reimbursement system. Mortality rates were studied by non-parametric (Kaplan-Meier survival analysis) and semi-parametric (Cox proportional hazard regression) approaches. Results:The annual number of prevalent CLL patients is 3-4,000 with 8-900 newly diagnosed patients annually. The assessment was based on at least two relevant and confirmed C91.10 ICD diagnoses in inpatient or outpatient care. Kaplan-Meier curve estimates show the median overall survival from diagnosis is 80 months. The survival probability at one elapsed year is 91% in CLL patients diagnosed between the years 2002-2013, and 95% in the years between 2007-2013. The 4-year survival probability is 67% for patients diagnosed between the years of 2002-2013 and 78% for patients diagnosed between the years 2007-2013 (Figure 1 below). By fitting Cox model with age covariates, it can be shown that there is significant difference in relative risk (RR) of death in different age cohorts. The RR of death in the 60-69 age cohort is 1.5 times and in the 70-79 age cohort is more than 2 times higher than in the 50-59 age cohort of CLL patients. Figure 1 Survival analysis from first diagnosis by Kaplan-Meier method Figure 1. Survival analysis from first diagnosis by Kaplan-Meier method Conclusion: These results from this analyses show a significant increase of survival in Hungary over the last 15 years. The availability of treatment options have contributed to this increased survival probability. This population, real-world data confirms the relevance of age at first diagnosis as predictor for overall survival. Recently approved therapies in CLL, e.g. Ibrutinib are expected to further improve the mortality outcome for this patient group. Disclosures Gaudig: Janssen : Employment. Vályi-Nagy:Janssen-Cilag Ltd.: Consultancy. Takacs:Janssen-Cilag Ltd. Hungary: Employment. Bacskai:Healthware Consulting Ltd: Equity Ownership. Kozma:Janssen-Cilag Ltd. Hungary: Employment. Rakonczai:Healthware Consulting Ltd: Employment. Püspöki:Healthware Consulting Ltd: Employment.

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