scholarly journals Understanding Oncological Disparities in Mycosis Fungoides within Hispanic Enriched Communities

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 5016-5016
Author(s):  
Rodolfo Garza-Morales ◽  
Carolina Velez-Mejia ◽  
Qianqian Liu ◽  
Joel E Michalek ◽  
Adolfo Enrique Diaz Duque
Keyword(s):  
Survival Time ◽  
Mycosis Fungoides ◽  
Survival Probability ◽  
Research Funding ◽  
Private Insurance ◽  
Statistical Testing ◽  
Insurance Status ◽  
Poverty Index ◽  
Significant Difference ◽  
Age Of Diagnosis

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

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

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4081-4081
Author(s):  
Brian Warnecke ◽  
Daniel Rosas ◽  
Alexandra Wehbe ◽  
Qianqian Liu ◽  
Joel E Michalek ◽  
...  
Keyword(s):  
Survival Time ◽  
Median Survival ◽  
Survival Probability ◽  
Median Survival Time ◽  
Research Funding ◽  
Cell Lymphoma ◽  
Poverty Index ◽  
Significant Difference ◽  
Mantle Cell ◽  
Age Of Diagnosis

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

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.

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.

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

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4531-4531
Author(s):  
Abhishek Pandya ◽  
Munaf Al-Kadhimi ◽  
Qianqian Liu ◽  
Joel E Michalek ◽  
Adolfo Enrique Diaz Duque
Keyword(s):  
Survival Time ◽  
Hodgkin Lymphoma ◽  
Median Survival ◽  
Survival Probability ◽  
Research Funding ◽  
Poverty Index ◽  
Survival Probabilities ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Race Ethnicity

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

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

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 12-12
Author(s):  
Lakene Raissa Djoufack Djoumessi ◽  
Snegha Ananth ◽  
Michael E Auster ◽  
Joel E Michalek ◽  
Qianqian Liu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Median Survival ◽  
Survival Probability ◽  
Research Funding ◽  
Marginal Zone ◽  
Marginal Zone Lymphoma ◽  
Age At Diagnosis ◽  
Poverty Index ◽  
Hispanic Origin ◽  
Significant Difference

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

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

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 18-19
Author(s):  
Michael M. Song ◽  
Abhishek Pandya ◽  
K Tai Lucero ◽  
James J Yoo ◽  
Joel E Michalek ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Combination Chemotherapy ◽  
Survival Probability ◽  
Research Funding ◽  
Cell Lymphoma ◽  
Poverty Index ◽  
Recommended Treatment ◽  
Significant Difference ◽  
Mantle Cell ◽  
Stage 1

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

scholarly journals A First Large Statewide Population Based Study Evaluating Racial Differences in Treatment and Survival between Hispanics and Non-Hispanics with Diffuse Large B Cell Lymphoma (DLBCL)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 9-9
Author(s):  
Daniela Hernandez ◽  
Carolina Velez-Mejia ◽  
Joel E Michalek ◽  
Qianqian Liu ◽  
Adolfo Enrique Diaz Duque
Keyword(s):  
Survival Time ◽  
Racial Differences ◽  
Survival Probability ◽  
Research Funding ◽  
B Cell Lymphoma ◽  
Population Based ◽  
P Value ◽  
Poverty Index ◽  
Large B Cell Lymphoma ◽  
Kaplan Meier

BACKGROUND: Diffuse Large B Cell Lymphoma (DLBCL) is the most common and most aggressive subtype of Non-Hodgkin Lymphoma. (Blood PMID: 9166827) Despite significant advances, treatment survival remains heterogenous due to biologic differences and perhaps ethnic and racial disparities. Multiple epidemiological studies have evaluated racial differences, mainly comparing African Americans (AA) with Non-Hispanic (NH), showing AA patients have a 10-20% higher risk of death. (BMC PMID: 21073707, Leuk PMID: 22800091, Cancer PMID: 24048801) A recent study showed how socioeconomic factors also influence patient survival and this can be linked to racial differences as well. (Blood PMID: 24705494). Small sample studies have characterized DLBCL in Hispanics (HI) but no definite conclusions have been drawn. (ASH Blood 2018 132:4867, JCO 10.1200, Blood (2019) 134 (Supplement_1): 2916). The need of larger studies to characterize survival differences establishes the basis of our population-based analysis in Texas comparing DLBCL in HI vs NH. METHODS: This is a retrospective study of a cohort of patients diagnosed with lymphoma from the Texas Cancer Registry (TCR) database. Patients with DLBCL diagnosed from 2006 to 2016 were identified by the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. 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. Categorical outcomes were summarized with frequencies and percentages and age (years) was the only continuously distributed outcome with the mean and standard deviation. The significance of variation in the distribution of categorical outcomes with ethnicity (HI, NH) was assessed with Fisher's Exact tests or Pearson's Chi-square tests as appropriate; age was assessed with T-tests or Wilcoxon tests as appropriate. Survival time was measured in years from date of primary diagnosis to date of death. Patients not coded as dead were considered censored on survival time at the date last seen. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. 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%. RESULTS: A total of 15,083 patients met inclusion criteria, with 3583 HI and 11500 NH diagnosed with DLBCL from 2006 to 2016. Demographic data was analyzed and compared between both groups, (Fig 1A). The median age of diagnosis was 61.7 on HI population and 65 on the NH. Among the HI population most of the patients were of Mexican origin (25%). HI have a higher percentage (24%) of non-insured or Medicaid than NH (8%) with a significant p value of <0.001 and a statistically significant higher poverty index within HI with 54% living on a 20-100% poverty land. Staging was similar between both groups. Most of the patients, 46% of HI and 45% of NH, have a stage III-IV grade DLBCL. The NH population received more treatment with chemotherapy 4% compared to 2% of the HI group, but this difference was not statistically significant. Both groups received similar treatments with bone marrow transplant, or radiation. The median survival time was similar between HI and NH, 4.4 and 4.3 years respectively. Survival probability at 2, 5 and 10 years for HI was 0.59 (CI 0.576,0.611), 0.48 (CI 0.467, 0.506) and 0.301 (CI 0.265,0.34) respectively. For NH the survival probability was similar, 0.602 (CI 0.592,0.611), 0.473 (CI 0.463,0484) and 0.242 (CI 0.223,0.262) respectively (Fig 1B). The overall survival probability at 10 years did not show a statistically significant difference for HI vs NH (p-value 0.46) (Fig 1C). CONCLUSION. Despite demographic disparities between HI and NH, and statistically significant differences with more HI patients uninsured and a higher index of poverty land; there was no significant distinction in overall survival in patients with DLBCL. The findings suggest no impact of ethnicity to that regard. 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.

Evaluation of Health Related Questionnaire Among Mycosis Fungoides and Lymphomatoid Papulosis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5603-5603 ◽  
Author(s):  
Rakhshandra Talpur ◽  
Iris Wieser ◽  
Casey Wang ◽  
Lyons Genevieve ◽  
Madeleine Duvic
Keyword(s):  
Quality Of Life ◽  
Board Of Directors ◽  
Mycosis Fungoides ◽  
Research Funding ◽  
Brentuximab Vedotin ◽  
Function Score ◽  
Advisory Committees ◽  
Significant Difference ◽  
And Function

Abstract INTRODUCTION AND OBJECTIVES: Mycosis Fungoides (MF) andlymphomatoid papulosis (LyP) are relatively rare and itchy skin disorders. The cosmetic disfigurement and severe pruritus dramatically affects the patient's quality of life. The focus is to examine the validity and reliability of the skindex-29, M.D. Anderson symptom inventory (MDASI) and itch-related quality of life (IQOL) questionnaire in 62 patients in a phase II trial of Brentuximab Vedotin. MATERIALS AND METHODS: Patients completed survey questionnaires related to symptoms and quality-of-life several times over the course of Brentuximab Vedotin. We compared patients' baseline scores to their end-of-study (EOS) scores. Patients were grouped by diagnosis into Mycosis Fungoides and Lymphomatoid papulosis group. Questionnaires included skindex-29, focusing on the skin conditions the patient was bothered the most. (MDASI) for patients with cancer and following the symptoms of cancer and the itchy quality of life (I-QoL) questionnaire was developed to measure the symptoms associated with cancer therapeutic agents and their effect on daily activities. Scoring for the Skindex-29, M. D. Anderson Symptom Inventory (MDASI) and the Quality of Life (QOL) survey were done according to the questionnaire specific scoring guide. Responses were compared between 2 groups using the Wilcoxon rank-sum test. RESULTS Questionnaires from 62 patients (23 LyP and 39 MF) were studied at baseline and end of study. Patients were 33 males and 29 females with median age of 60 years (range: 27-86 years). The median overall survival (OS) was significant P = 0.041, when comparing patients with MF to LyP. The median survival time for patients from time of diagnosis with MF was 14.66 years and LyP was not reached. There was no significant difference in progression free survival (PFS) between MF and LyP. The median number of Brentuximab Vedotin cycles was 7 (1-19). Skindex-29 scales, showed change in emotion scale and function scale from baseline to EOS, both groups had a decrease, patients with LyP had a larger decrease in emotion score (P = 0.069) and function score (P =0.096) over the course of the study. There was no difference in the symptom scale from baseline to EOS. The patients with LyP had a larger decrease in function score from baseline to EOS. When comparing patients with MF to those with LyP for MDASI, there is no evidence of a difference, from baseline to EOS, in either symptom severity or symptom interference in daily life. In the IQOL when comparing the LyP patients' QOL responses from baseline to EOS, did not show significant difference. Table 1. Change in Skindex-29 scales, by group Skindex Scale MF LYP p-value Change from baseline to end-of-study: N Median Min Max N Median Min Max Emotion 35 -10 -65 35 20 -22.50 -61.94 12.5 0.0698 Symptoms 35 -7.14 -46.43 42.86 20 -10.71 -53.57 28.57 0.4782 Function 35 -2.08 -50.38 27.08 20 -16.29 -44.70 14.58 0.0962 Table 2. Change in MDASI scales, by Diagnosis MDASI Scale Item MF LYP p-value Change from baseline to end-of-study: N Median Mean Std. Dev Range N Median Mean Std. Dev Range Severity 35 0.23 0.18 1.96 (-5.85, 3.15) 21 0.38 0.46 1.61 (-1.69, 5.0) 0.9595 Interference 35 0.17 0.06 3.07 (-9.17, 5.17) 19 0.0 0.11 1.59 (-3.0, 4.67) 0.6764 CONCLUSIONS A significant improvement in emotions and functional part of skindex-29 was observed when comparing patients with MF to patients with LyP. While both groups had a decrease, the patients with LyP had a larger decrease in emotion and function score over the course of the study. Disclosures Duvic: Celgene: Membership on an entity's Board of Directors or advisory committees; Rhizen Pharma: Research Funding; Allos (spectrum): Research Funding; Therakos: Research Funding, Speakers Bureau; Soligenics: Research Funding; Huya Bioscience Int'l: Consultancy; Spatz Foundation: Research Funding; MiRagen Therapeutics: Consultancy; Eisai: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Oncoceutics: Research Funding; Array Biopharma: Consultancy; Cell Medica Ltd: Consultancy; Tetralogics SHAPE: Research Funding; Innate Pharma: Research Funding; Kyowa Hakko Kirin, Co: Membership on an entity's Board of Directors or advisory committees, Research Funding.

scholarly journals Insurance Status Impacts Survival in Burkitt Lymphoma

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 916-916
Author(s):  
Jordan S. Goldstein ◽  
Jeffrey M. Switchenko ◽  
Madhusmita Behera ◽  
Christopher Flowers ◽  
Jean L. Koff
Keyword(s):  
United States ◽  
Research Funding ◽  
Private Insurance ◽  
The United States ◽  
Insurance Status ◽  
Proportional Hazard ◽  
Comorbidity Score ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Insured Patients

Abstract Introduction: Burkitt lymphoma (BL) is an aggressive non-Hodgkin lymphoma with an estimated 1480 new cases diagnosed in the United States in 2016. BL is simultaneously one of the most aggressive lymphomas, with a tumor volume doubling time of just 24 hours, and one of the most curable, with several clinical trials showing 3-year survival rates over 80%. However, recent studies have identified a significant discrepancy between clinical trial and "real-world" survival, implying access to care may play an important role in BL outcomes. A patient's insurance status represents a major factor in the utilization of cancer therapies and outcomes in the United States. Underinsured patients are more likely to be diagnosed at an advanced stage, receive substandard therapy, and have worse outcomes. We examined the effect of insurance status on survival in adults with BL and compared the impact of insurance status on BL outcomes to that seen in plasmablastic lymphoma (PBL), an aggressive lymphoma that has poor outcomes regardless of treatment. Methods: We used data from the National Cancer Database (NCDB), a nationwide, hospital-based cancer registry jointly sponsored by the American Cancer Society and American College of Surgeons that contains 34 million historical records and captures 75% of newly diagnosed cancer cases in the United States. Commission on Cancer (CoC)-accredited facilities report patients' vital status and date of death to the NCDB annually. We included patients > 18 years old diagnosed 2004-2014 with BL or PBL as the primary tumor who received all or part of initial course of treatment at the reporting facility. Patients missing information on insurance status or survival were excluded, as were those who had non-Medicare/Medicaid government insurance (VA, Indian Health Services). Chi-square tests were used to compare sociodemographic and clinical characteristics by insurance status. All analyses were performed for both BL and PBL and stratified on age 65, due to changes in eligibility for Medicare at that age. Kaplan-Meier survival curves were stratified by insurance status, and log-rank tests were performed. Univariate Cox proportional hazard models were generated to describe the unadjusted associations for the covariables, and multivariable Cox proportional hazard models were generated to estimate the hazard ratio (HR) associated with insurance status when adjusted for prognostic factors. Results: We identified 7,073 BL patients and 475 PBL patients in the NCDB who met inclusion criteria. Of the 5235 BL patients < 65 years, 65.0% had private insurance, 17.2% had Medicaid, 7.6% had Medicare, and 10.2% had no insurance. Of the 1838 BL patients ≥ 65 years, 12.9% had private insurance, 1.5% had Medicaid, 85% had Medicare, and 0.65% had no insurance. Uninsured and Medicaid-insured patients were more likely to be Hispanic or black, have lower socioeconomic status (SES), have B symptoms, be HIV-positive, and have a Charlson-Deyo comorbidity score ≥ 2 when compared with privately insured patients. Medicare patients were more likely to be female, have ≥1 comorbidity, and not receive chemotherapy treatment when compared to privately insured patients. BL patients without private insurance had significantly worse overall survival compared to those with private insurance, regardless of age group (adjusted HR age <65: uninsured 1.41 [95% confidence interval 1.2,1.7], Medicaid 1.17 [1,1.4], Medicare 1.5 [1.2,1.8]; adjusted HR age ≥ 65: uninsured 6 [2.1,17.3], Medicare 1.33 [1,1.8]; see Figure). Conversely, Cox regression models demonstrated that PBL patients without private insurance experienced no significant differences in overall survival in either age group. For BL patients age <65, low SES, presence of B symptoms, advanced stage, HIV-positive status, comorbidity score ≥ 2, and lack of treatment were significant, independent predictors of worse outcomes and contributed to the disparities in survival by insurance status. For BL age > 65, B symptoms, comorbidity score ≥ 2, and lack of treatment were significant, independent predictors of worse outcomes. Conclusion: We identified insurance status as an important predictor of clinical outcomes for BL. Our findings suggest that expanding access to care may improve survival disparities in BL, for which curative therapy exists, but not PBL, where more effective therapies are needed to improve outcomes. Disclosures Flowers: Celgene: Consultancy, Research Funding; Bayer: Consultancy; V Foundation: Research Funding; Research to Practice: Research Funding; Infinity: Research Funding; Acerta: Research Funding; National Institutes Of Health: Research Funding; Clinical Care Options: Research Funding; Educational Concepts: Research Funding; Abbvie: Consultancy, Research Funding; Pharmacyclics LLC, an AbbVie Company: Research Funding; OptumRx: Consultancy; Spectrum: Consultancy; Genentech/Roche: Consultancy, Research Funding; National Cancer Institute: Research Funding; Eastern Cooperative Oncology Group: Research Funding; Onyx: Research Funding; Burroughs Welcome Fund: Research Funding; TG Therapeutics: Research Funding; Prime Oncology: Research Funding; Millennium/Takeda: Research Funding; Janssen Pharmaceutical: Research Funding; Seattle Genetics: Consultancy; Gilead: Consultancy.

scholarly journals Primary Central Nervous System Lymphoma: A Retrospective Study of the Population of Texas and Florida with an Emphasis on Survival Outcomes on Hispanics Vs Non-Hispanics

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1443-1443
Author(s):  
Kana Tai Lucero ◽  
Lakene Raissa Djoufack Djoumessi ◽  
Joel E Michalek ◽  
Qianqian Liu ◽  
Adolfo Enrique Diaz Duque
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Research Funding ◽  
Central Nervous System Lymphoma ◽  
Survival Outcomes ◽  
P Value ◽  
Poverty Index ◽  
Significant Difference ◽  
The U.S

Abstract Introduction Primary central nervous system lymphoma (PCNSL) is a devastating subtype of extranodal non-Hodgkin's lymphoma (NHL) that accounts for ~4% of newly diagnosed central nervous system (CNS) tumors. (NeuroOncol PMID: 21915121) The age-adjusted incidence of PCNSL in the U.S. has increased since the 1970s. (ACS PMID: 19273630) despite advances in the treatment of lymphoma, and clinical outcomes remain poor with an estimated 5- year survival for immunocompetent patients at 30%. (NCBIPMID:31424729) Trends in outcomes of PCNSL have been reported, but sub-analyses for minorities like Hispanics (HI), have not been widely studied. Understanding ethnic disparities on outcomes and patterns of care in PCNSL are crucial given the rapid growth of HI in the U.S. This study aims to examine the demographics, treatment patterns, and survival outcomes of PCNSL in HI compared to Non-Hispanics (NH) in Texas (TX) and Florida (FL). Methods This is a retrospective study of a cohort of patients diagnosed with lymphoma (Hodgkin and Non-Hodgkin) from the TX Cancer Registry (TCR) and the FL Cancer Data System (FCDS) from 2006-2017. Patients with PCNSL were identified by the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. Standard demographic variables collected include gender, ethnicity, dates at diagnosis and death, primary payer at diagnosis, type of treatment and poverty index (PI). The significance of variation in the distribution of categorical outcomes with ethnicity (HI and 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 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 The study included 1969 patients (TX: n=297 HI, n= 708 NH; FL: n=149 HI, n=415 NH). PCNSL was diagnosed at younger median age in HI (TX: 59,FL:59) compared to NH (TX: 62, FL:63),with a significant difference noted within each state (TX: p= 0.005; FL: p=0.007). HI in TX were identified primarily as Mexican, Spanish or NOS/Hispanic. There was a significant predominance of overall males (M) in TX (p=0.009). There was a non-significant predominance of M in FL. Regarding poverty index (PI), there were more HI (TX:51% and FL: 35%) in the 20-100% bracket than NH (TX: 25%; FL: 22%). Conversely there were more NH in all other PI in TX and FL. Government sponsored insurance was the most common insurance in all subgroups. This reached a significant predominance in HI (54%) and NH (54%) in TX (p<0.001). There was no significant difference in insurance types between HI and NH in FL(p=0.772). Regarding chemotherapy there was a trend to either use multiple agents [(TX: 34% in HI vs 32% in NH; p=0.68); (FL: 33% in HI vs 67% in NH; p=0.042)] or to not offer chemotherapy at all [(TX: 26% in HI vs 29% in NH; p= 0.68); (FL: 44% in HI vs 33% in NH; p=0.042)] with significant differences noted in FL only. (Table 1) The median survival (MS) for HI and NH in TX was similar in years (y) at 0.8 while the MS time in FL for HI vs NH was higher (1.3 vs 0.6 respectfully) Thus, the MS for HI in FL was higher compared to NH in FL and HI and NH in both TX and FL. (Table 2) The survival probability for HI was shorter at 2 and 5 years compared to NH in TX with a non-significant overall survival (OS) probability (p-value=0.19) seen in Figure 1. Significantly, the survival probability of HI in FL at 2, 5 and 10 years was higher compared to NH with an OS probability (p-value=0.0063) seen in Figure 2. Conclusion This retrospective study showed a statistically significant difference in OS probabilities at all years between HI and NH in FL with PCNSL. The OS probability also remained higher in HI in FL compared to both HI and NH in TX. In addition, the study demonstrated a longer MS in HI in FL compared to not only HI in TX, but also both NH in TX and FL. Sociodemographic differences like gender and insurance types were noted between HI in TX and FL. HI origin groups are also a subject of interest. The primary HI origin group in TX were Mexican and not otherwise specified (NOS). This data was missing for FL HI. Future studies should be conducted to uncover any further disparities between these two HI populations to explore the impact of access to care and disease biology on PCNSL survival outcomes. 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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