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

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.

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

Blood ◽

10.1182/blood-2020-142502 ◽

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.

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

Blood ◽

10.1182/blood-2020-136485 ◽

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.

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Outcome of Diffuse Large B Cell Lymphoma in the VA System: The Rituximab Era.

Blood ◽

10.1182/blood.v108.11.4729.4729 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4729-4729

Author(s):

Rami S. Komrokji ◽

Sanjay Maraboyina ◽

Rami Y. Haddad ◽

Zeina A. Nahleh ◽

Malek M. Safa

Keyword(s):

Overall Survival ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Population Based ◽

Wilcoxon Test ◽

P Value ◽

Medical Centers ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Background: Addition of rituximab to chemotherapy in patients with diffuse large B cell Lymphoma (DLBCL) has been shown to improve survival in several recent clinical studies. A study from British Columbia confirmed those results in a population-based cohort. No similar population based studies were conducted in the USA. Our study aims to address outcome of DLBCL in the era of rituximab in the VA health system. Methods: This was a retrospective analysis. The VA Central Cancer Registry (VACCR) database was used to identify patients with DLBCL diagnosed between 1995 and 2005. There are approximately 120 VA medical centers diagnosing and/or treating patients with cancer. The VACCR aggregates the data collected by the medical centers’ cancer registries. Data were extrapolated and analyzed using bio-statistical software SPSS. Variables included age, sex, stage of disease, histology subtype, date of diagnosis, date of last contact, date of relapse, vital status, whether patients received chemotherapy and or radiation. Use of rituximab was not specifically recorded in the registry. Due to that we divided the patients into two groups, patients diagnosed with DLBCL before 2001 (pre rituximab era group) and patients diagnosed after 2001 (rituximab era group). The initial results of rituximab in DLBCL were presented in 2000 and published in January 2002. Independent t test was used for comparing continuous variables and chi square test for categorical variables. Wilcoxon test was used to compare survival among the two groups. Results: There were 2792 patients with DLBCL at the VACCR between 1995 and 2005, 1772 patients in pre rituximab era and 1020 patients in the rituximab era. The mean age at diagnosis was to 64 in pre rituximab group and 66 in rituximab group (P-value 0.015). Race distribution was similar between the two groups. More patients were diagnosed at advanced stage (stage III and IV) 61 % in rituximab group compared to 57% in pre rituximab group (P-value <0.005), IPI score data were not available. More patients in pre rituximab era did not receive multi-agent chemotherapy 28% versus 22% (P-value < 0.005). More patients received radiation 21 % in pre rituximab group compared to 16% in rituximab era group (P-value < 0.005). The 5-year overall survival was 26% in pre rituximab era and 36% after rituximab (P-value 0.0025). Using Cox regression multivariable analysis age, use of mutli-agent chemotherapy, radiation and whether patients were diagnosed and treated before or after 2001 were statistically significant independent variables affecting survival. Conclusions: Overall survival of DLBCL in VA patients had improved in the rituximab era. The magnitude of improvement observed in this study is similar to what was described in previous studies. Other factors contributing to improvement in outcomes such as supportive care could not be differentiated in this study. This is a population-based study suggesting improvement in survival in DLBCL in the rituximab era.

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Increased incidence but improved median overall survival for biliary tract cancers diagnosed in Ontario from 1994 through 2012: A population-based study

Cancer ◽

10.1002/cncr.30074 ◽

2016 ◽

Vol 122 (16) ◽

pp. 2534-2543 ◽

Cited By ~ 13

Author(s):

Jennifer A. Flemming ◽

Jina Zhang-Salomons ◽

Sulaiman Nanji ◽

Christopher M. Booth

Keyword(s):

Overall Survival ◽

Biliary Tract ◽

Median Overall Survival ◽

Population Based ◽

Population Based Study ◽

Biliary Tract Cancers

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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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The Impact of Insurance Status at Diagnosis on Overall Survival in Chronic Myeloid Leukemia: A Population-Based Analysis

Blood ◽

10.1182/blood.v126.23.631.631 ◽

2015 ◽

Vol 126 (23) ◽

pp. 631-631

Author(s):

Ashley M. Perry ◽

Tao Zou ◽

Andrew M. Brunner ◽

Donna S Neuberg ◽

Amir T. Fathi

Keyword(s):

Overall Survival ◽

Marital Status ◽

Board Of Directors ◽

Research Funding ◽

Multivariable Analysis ◽

Population Based ◽

P Value ◽

Insurance Status ◽

Advisory Committees ◽

Hispanic Ethnicity

Abstract Introduction: Survival among patients diagnosed with chronic myeloid leukemia (CML) has markedly improved with the advent of tyrosine kinase inhibitors. Nonetheless, access to care, including medication cost and adherence, may be barriers to therapeutic effectiveness. We performed a population-based analysis to determine if insurance status at the time of CML diagnosis influenced patient outcomes. Methods: We used the Surveillance, Epidemiology, and End Results Program (SEER) database (November 2014 submission) to identify patients age 15 or older, diagnosed with CML between 2007 and 2012 (SEER ICD-O3 recodes 9863 and 9875). We included patients with documented insurance status at diagnosis and categorized them as either private insurance, Medicaid coverage, or uninsured. We excluded patients with unknown insurance status at diagnosis. The primary outcome was overall survival according to insurance status. We performed a stratified analysis looking at patients age 15-64 and patients 65 or older; we did not include uninsured patients over age 65 in the analysis (n=16) due to Medicare eligibility. Covariates of interest in multivariable analysis included age at diagnosis, race, ethnicity, sex, and marital status at diagnosis. Overall survival was compared by log-rank test and estimated by the method of Kaplan and Meier. P-values were significant to the 2-sided 0.05 level. Results: 5784 patientswere diagnosed with CML between 2007 and 2012 and had insurance status documented at diagnosis. Of patients age 15-64, uninsured and Medicaid patients were younger, more often non-white race and Hispanic ethnicity, and less often married (Table 1). Over age 65, Medicaid patients were more often female, non-white race and Hispanic ethnicity, and less often married. Median follow up was 32 months. Among patients age 15 to 64, being uninsured or having Medicaid was associated with worse survival compared to insured patients (5-year OS uninsured 72.7%, Medicaid 73.1%, insured 86.6%, p<0.0001) (Figure 1A). For patients over age 65, there was no difference in 5-year OS between patients with Medicaid and those with other insurance (40.2% vs. 43.4%, p=0.0802). In multivariable analysis of patients age 15-64, compared to insured patients, there was increased mortality among patients who were uninsured (HR 2.156, p<0.0001) or on Medicaid (HR 1.972, p<0.0001). There was worse survival with increased age (HR 1.046 per year, p<0.0001), male sex (HR 1.282, p=0.0279) and, compared to married persons, being single (HR 1.883, p<0.0001). For patients over age 65 at diagnosis, only age was associated with increased mortality (HR 1.078 per year, p<0.0001). Conclusions: CML patients under age 65 without insurance or with Medicaid had significantly worse survival compared to patients with insurance. This difference was not noted with patients over age 65; whose survival was relatively poorer regardless of insurance status, as previously described (Cancer 2013;119:2620). Marital status and race/ethnicity also impacted survival. Despite highly effective therapies currently available for CML, these findings suggest that many patients may not have access to or receive appropriate care, in part related to insurance coverage. Table 1. Patient Demographics Age 15-64 p-value Age 65+ p-value (3626 patients) (2142 patients) Uninsured Medicaid Insured Medicaid Insured Total, n (%) 321 (8.9%) 595 (16.4%) 2710 (74.7%) 190 (8.9%) 1952 (91.1%) Age, median (range) 44 (18-64) 45 (15-64) 50 (15-64) <0.0001 75 (65-97) 76 (65-102) 0.5388 Gender, n (%) 0.0482 0.0074 Male 203 (63%) 328 (55%) 1603 (59%) 86 (45%) 1087 (56%) Female 118 (37%) 267 (45%) 1107 (41%) 105 (55%) 865 (44%) Race, n (%) <0.0001 <0.0001 White 231 (72%) 402 (68%) 2112 (78%) 131 (69%) 1724 (89%) Black 68 (21%) 114 (19%) 313 (12%) 26 (14%) 144 (7%) American Indian 2 (1%) 25 (4%) 13 (0.5%) 2 (1%) 7 (0.4%) Asian, Pacific Islander 15 (5%) 48 (8%) 215 (8%) 30 (16%) 65 (3%) Unknown 5 (2%) 6 (1%) 57 (2%) 1 (0.5%) 12 (0.6%) Hispanic Ethnicity, n (%) <0.0001 <0.0001 Non- 234 (73%) 420 (71%) 2341 (86%) 151 (79%) 1813 (93%) Hispanic Hispanic 87 (27%) 175 (29%) 369 (14%) 39 (21%) 139 (7%) Marital Status, n (%) <0.0001 <0.0001 Single 141 (46%) 281 (50%) 588 (23%) 41 (23%) 153 (9%) Married/partner 123 (40%) 194 (34%) 1652 (65%) 67 (37%) 1069 (59%) Divorced/separated/widowed 45 (15%) 90 (16%) 288 (11%) 72 (40%) 578 (32%) Figure 1. Survival of patients (A) age 15-64 and (B) age 65+ by insurance status at diagnosis. Figure 1. Survival of patients (A) age 15-64 and (B) age 65+ by insurance status at diagnosis. Disclosures Fathi: Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda Pharmaceuticals International Co.: Research Funding; Ariad: Consultancy; Exelexis: Research Funding; Agios: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees.

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Impact of the addition of rituximab in overall survival in first line chemotherapy in follicular lymphoma: a population-based study from the Spanish Lymphoma Oncology Group (GOTEL)

Annals of Oncology ◽

10.1093/annonc/mdw375.09 ◽

2016 ◽

Vol 27 ◽

pp. vi315

Author(s):

M. Torrente ◽

P. Sabin ◽

J. Gomez Codina ◽

Ldela Cruz Merino ◽

M. Llanos ◽

...

Keyword(s):

Overall Survival ◽

Follicular Lymphoma ◽

Population Based ◽

Oncology Group ◽

First Line ◽

Population Based Study ◽

Line Chemotherapy

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Overall Survival Patterns in Patients with Multiple Myeloma in the Era of Novel Agents and the Role of Initial Clinical Presentation and Comorbidities: A Population-Based Study

Blood ◽

10.1182/blood.v124.21.2136.2136 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2136-2136

Author(s):

Berdien Oortgiesen ◽

Eric N. van Roon ◽

Peter Joosten ◽

Robby Kibbelaar ◽

Huib Storm ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

The Netherlands ◽

Research Funding ◽

Clinical Presentation ◽

Population Based ◽

Novel Agents ◽

Bone Lesions ◽

Population Based Study ◽

Asymptomatic Patients

Abstract Introduction Clinical trials have shown improved response rates, progression-free survival and overall survival (OS) in patients with multiple myeloma (MM) when using the novel agents thalidomide, lenalidomide and bortezomib. However, outcome data provided by population-based registries, reflecting real-life, report predominantly improved OS in younger MM patients and only minimal improvement in OS in unselected MM patients older than 65 years. Population-based studies in unselected MM patients in the era of novel agents are relatively limited. Explanations for the marked variation in prognosis across patients may in part be explained by the heterogeneity in the initial clinical presentation, the pre-existing comorbidities, disease biology and response to the therapy. Specific end-organ damage caused by the disease, such as hypercalcemia, renal failure, anemia and bone lesions known as the CRAB symptoms may be associated with worse prognosis in the elderly MM patients. This descriptive prospective population-based cohort study was designed to determine the OS in patients with MM in Friesland, The Netherlands in the era of novel agents, and to analyze the influence of the CRAB symptoms and comorbidities at initial presentation on survival. Methods Since 2005 all patients diagnosed with hematological malignancies in Friesland, a province of the Netherlands, are prospectively registered and followed by their clinicians in a population-based registry, the HemoBase. For this analysis, data on clinical characteristics, comorbidities, treatment and outcome of all patients with newly diagnosed MM in Friesland during the period of January 2005 to January 2013 with a follow-up until January 2014 were retrieved from HemoBase. Supplementary information was obtained from the individual patient hospital records. Both symptomatic and asymptomatic patients were included in the study with subgroup analysis on the symptomatic patients. According to the guidelines from IMWG, each CRAB symptom was divided into two categories (11 mg/dL < serum calcium ≤ 11 mg/dL; 2 mg < creatinine ≤ 2 mg/dL; 10.2 g/d ≤ hemoglobin < 10.2 g/dL and the presence or absence of bone lesions). The patients were divided by age groups (<65, 65 – 75 and ≥75 years old) to illustrate differences in survival in the three age categories. Results From 2005 till 2013 a total of 270 patients were diagnosed with MM in Friesland. The median observation period was 29 months (range 0.26 - 104; IQR 33). Median age was 70 years (range 32 - 92; IQR 15) with a male predominance (60% male). 34, 34 and 32% of patients were < 65 years, 65 - 75 years and ≥ 75 years, respectively. The Charlson Comorbidity Index (CCI) was 0,1 or ≥2 in 60, 22, 18% of patients, respectively. Sixteen percent of patients were asymptomatic. Of symptomatic patients 63% and 27% had CRAB scores of 1-2 and 3-4, respectively. Ten percent of patients had a CRAB score of 0, but were regarded symptomatic by their treating hematologist. Among the symptomatic MM patients 80% received novel agents, 15% other chemotherapy 6% only radiotherapy. The median OS of all patients is 49.5 months, with median OS for symptomatic and asymptomatic patients of 40 and >100 months respectively. Divided into age categories < 65, 65 – 75 and ≥75 years old, the 50% OS is respectively 92, 40 and 29 months (figure 1). For all patients, implementing novel therapies improved OS compared to other therapies (43.5 vs. 21.1 months, hazard ratio (HR) = 1.8, P = 0.017. Patients with a CCI score of 0 have a higher median OS than patients with a score ≥ 2 (HR = 0.6, P = 0.036). Patients with two or more CRAB symptoms have a lower median OS than patients without any CRAB symptoms (HRadjusted = 2.2, P = 0.028). In multivariate analysis, differences in median OS were significant better for patients without hypercalcemia compared to patients with hypercalcemia (HRadj. = 0.6, P = 0.011) and for patients with a serum creatinine ≤ 2 mg/dL vs. ≥ 2 mg/dL (HRadj. = 0.4, P < 0.0001). Conclusion In this population-based study of a complete Dutch cohort of unselected MM patients over the last decade a median OS of 49.5 months was observed. Despite extensive introduction of novel agents increasing age remains an adverse prognostic factor. High comorbidity scores (CCI ≥ 2) and CRAB symptoms, such as hypercalcemia and impaired renal function at initial presentation were significantly correlated with worse median OS. Disclosures Hovenga: Jansen Cilag: Research Funding. Woolthuis:Jansen Cilag: Research Funding. Hoogendoorn:Jansen Cilag: Research Funding.

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Improved Survival in AL Amyloidosis: A Population-Based Study on 1,430 Patients Diagnosed in Sweden 1995-2013

Blood ◽

10.1182/blood.v128.22.4448.4448 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4448-4448 ◽

Cited By ~ 6

Author(s):

Brendan M. Weiss ◽

Sigrun H Lund ◽

Magnus Bjorkholm ◽

Adam D. Cohen ◽

Laura Dember ◽

...

Keyword(s):

Overall Survival ◽

Plasma Cell ◽

Research Funding ◽

Survival Rates ◽

Population Based ◽

Al Amyloidosis ◽

Population Based Study ◽

Cell Therapies ◽

Entire Cohort ◽

Over Time

Abstract Introduction: AL amyloidosis (AL) is a plasma cell disorder characterized by life-threatening vital organ dysfunction resulting in nearly a third of patients dying within the first year of diagnosis. The only available therapies are anti-plasma cell chemotherapy agents, which reduce the toxic and amyloidogenic immunoglobulin light chains. We have previously shown improved survival in multiple myeloma (MM) due to novel anti-plasma cell therapies. Studies from specialty amyloid centers have also shown improved survival in AL, but this has never been studied in a population-based setting. Methods: By using the nationwide Swedish Patient Registry we identified all individuals registered with AL amyloidosis (defined as more than one occurrence of the ICD-code E85.8 and E85.9) in Sweden 1995-2013. By using the Total Population Registry we identified four matched controls for each case of amyloidosis, matched by gender and year of birth, and the controls had to be alive at the time of diagnosis for the corresponding AL-amyloidosis case. By using the Cause of Death Registry we obtained information on date of death, with follow-up through 2013. Overall survival (OS) was analyzed using Kaplan-Meier method and Cox proportional model, adjusting for age, gender, and calendar period of diagnosis. The cohort was divided into 4 calendar periods to evaluate changes in overall survival (OS) over time. Results: We identified 1,430 AL patients; mean age at diagnosis of 66.3 years; male gender 58.5%. A diagnosis of MM was made in 10.7% of patients, 3.6% after the AL diagnosis (AL-MM) and 7.1% before the AL diagnosis (MM-AL). Compared to matched controls, AL patients in the entire cohort had a median OS of 1.72 years, median OS was not reached for controls (p<0.001). The median OS of MM-AL was 0.51 years, AL-MM 0.88 years and AL 1.87 years (p<0.001). Median OS for AL patients improved significantly over time: 0.77 years for 1995-99, 1.37 years for 2000-04, 1.85 years for 2005-09, and 3.48 years for 2010-2013 (p for trend <0.001). Survival improvements over time were observed in both those younger and older than age 65. The 1-year survival for AL patients was: 43% for 1995-1999, 58% for 2000-2004, 59% for 2005-2009 and 70% 2010-2013 (p<0.001). The 2-year survival rates: 30% for 1995-1999, 42% for 2000-2004, 49% for 2005-2009 and 61% 2010-2013 (p<0.05). Conclusions: In the first population-based study of outcomes in AL, based on almost 1,500 patients diagnosed during almost 20 years, we found that OS has improved over time. The most probable explanation is the availability of highly-effective anti-plasma cell agents and possibly improvement in supportive care. We have also demonstrated an improvement in early mortality in AL amyloidosis possibly due to earlier recognition of disease and prompt anti-plasma cell chemotherapy. This novel finding deserves further investigation. Figure 1 Figure 1. Disclosures Weiss: Prothena: Other: Travel, accommodations, Research Funding; GlaxoSmithKline: Consultancy; Millennium: Consultancy, Other: Travel, accommodations; Janssen: Consultancy, Other: Travel, accommodations, Research Funding; Novartis: Consultancy. Cohen:Bristol-Meyers Squibb: Consultancy, Research Funding; Janssen: Consultancy. Landgren:Amgen: Honoraria, Research Funding; BMS: Honoraria; Celgene: Honoraria, Research Funding; Takeda: Honoraria; Merck: Honoraria; Medscape Myeloma Program: Honoraria.

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