Racial Disparities in Diffuse Large B Cell Lymphoma: A VA Population Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4614-4614
Author(s):  
Sanjay Maraboyina ◽  
Rami S. Komrokji ◽  
Rami Y. Haddad ◽  
Zeina A. Nahleh ◽  
Malek M. Safa
Keyword(s):  
Family History ◽  
Racial Disparities ◽  
Racial Differences ◽  
Wilcoxon Test ◽  
P Value ◽  
Medical Centers ◽  
Black Patients ◽  
History Of ◽  
History Of Cancer ◽  
Large B Cell

Abstract Background: Racial disparities in diffuse large B cell non-Hodgkin’s lymphoma (DLBCL) are not well studied. Racial differences in outcome are not well recognized given majority of patients with DLBCL are white. The VA health care system offers a platform to study those racial differences given similar other variables and socioeconomic status among those patients. 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, family history of cancer, tobacco history, alcohol history, Agent orange exposure and whether patients received chemotherapy and or radiation. 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 VA system, 2402 white and 323 black patients. Sixty-seven patients from other racial groups were excluded from this analysis. The mean age of presentation among blacks was 57.8 years compared to 65.7 years among whites (P-value < 0.005). More Black patients had history of alcohol use, and smoking. More white patients had family history of cancer. No differences in histology subtypes were observed. Other baseline characteristics were similar. No difference in stage of disease was noted at presentation. IPI score data were not available. Similar proportion of patients received multi-agent chemotherapy among the two groups, 70 % for blacks and 67% for whites (P-value 0.58). Among blacks 16 % of patients received radiation while 19.5 % white patients did (P-value 0.73). The 5-year overall survival for blacks was 24 % compared to 29% for whites (P-value 0.92, Wilcoxon test). No statistically significant differences in survival were noted between the two races within each clinical stage. Using Cox regression multivariable analysis age, stage and chemotherapy were the only statistically significant independent variables affecting survival. Conclusions: DLBCL is less common among blacks. Blacks diagnosed with DLBCL are more likely to present at younger age. The treatment and outcome of DLBCL among blacks are not different from whites within the VA system.

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

Blood ◽  
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.

Examining the Racial Disparities In Presentation and Treatment for Patients with Diffuse Large B-Cell Lymphoma (DLBCL).

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1521-1521
Author(s):  
Pareen J Shenoy ◽  
Uma Borate ◽  
Kevin Bumpers ◽  
Tanyanika Douglas-Holland ◽  
Nassoma King ◽  
...  
Keyword(s):  
Family History ◽  
Racial Disparities ◽  
Annual Meeting ◽  
Racial Differences ◽  
Insurance Status ◽  
Relative Incidence ◽  
Emory University ◽  
History Of ◽  
To Receive ◽  
Over Time

Abstract Abstract 1521 Background: Data from the United States Surveillance, Epidemiology, and End Results (SEER) registry indicate that black (B) Americans have a lower relative incidence of DLBCL than Whites (W), but a higher disease-specific mortality (Malik, ASH Annual Meeting 2009). Studies of the SEER-Medicare (Vance, ASH Annual Meeting 2007) and National Cancer Database (Flowers, ASH Annual Meeting 2009) populations revealed that B patients (pts) with DLBCL were less likely to receive rituximab with chemotherapy, however, full details on clinical and demographic parameters that may influence incidence and treatment selection were not available in either dataset. To examine these racial disparities in a setting with more detailed ascertainment of presenting features and the use of cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) chemotherapy with or without rituximab (R), we studied the differences in presentation, socioeconomic status (SES), Family History, and treatment received by B and W patients with DLBCL at Emory University and UAB. Methods: Patients diagnosed with DLBCL at Emory University (1981-2010) and UAB (1985-2010) were identified from pathology, clinical and pharmacy records. Baseline demographic data, components of the International Prognostic Index (IPI: age, performance status (PS), lactate dehydrogenase (LDH), number of extranodal sites involved, and stage), B-symptoms, family history, insurance status, employment status, treatment and survival data were extracted. Racial differences in presentation, socio-demographic factors, and first-line treatment received were analyzed using Chi-squared statistical analysis. Results: A total of 862 (575 Emory and 287 UAB) patients with a confirmed diagnosis of DLBCL were identified. The median age of diagnosis for B pts (n=168) was significantly lower than that for W pts (n=607) [49 years (interquartile range [IQR] 36–60) vs. 57 years (IQR 46–69), p<0.001]. There were no differences in stage, PS, LDH level, or extranodal disease. Twice as many W pts (8%) as B pts (4%) had a positive family history of lymphoma (p=0.068). There were no B vs. W differences in employment (38% B vs. 39% W employed, p=0.822). However, fewer B pts were insured (94% B vs. 98% W, p=0.005), and insurance status differed by race (59% B vs. 79% W private, 17% B vs. 5% W Medicaid, 13% B vs. 11% W Medicare, p<0.001). R-CHOP use varied significantly over time (Figure), but contrary to previous reports there were no racial differences in the use of R-CHOP over time (52% B vs. 46% W, p=0.48). Pts who had elevated LDH were more likely to receive R-CHOP (p=0.022). Conclusions: These data corroborate findings that B pts present with DLBCL at a significantly younger age, and provide the impetus for examining racial differences in family history of lymphoma in population-based datasets as a possible contributing factor to the lower relative incidence of DLBCL in B population. In this setting of two regional referral centers with detailed ascertainment of treatment and few uninsured patients, there do not appear to be racial disparities in the adoption of R-CHOP for DLBCL. Disclosures: Foran: Genentech: Honoraria.

scholarly journals Prevalence of Hereditary Cancer Susceptibility Syndromes (HCSS) in Acute Lymphoblastic Leukemia (ALL): A Cross-Sectional Study in a Highly Consanguineous Population.

2021 ◽  
Author(s):  
Sara Aslam ◽  
Shabana NA ◽  
Mehboob Ahmed
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Family History ◽  
Genetic Counselling ◽  
Cancer Susceptibility ◽  
Lymphoblastic Leukemia ◽  
P Value ◽  
Early Age ◽  
Parental Consanguinity ◽  
History Of ◽  
History Of Cancer

Abstract Background: Hereditary cancer susceptibility syndrome (HCSS) has been reported to impact cancer predisposition at an early age, therefore, identification of HCSS has found to be crucial for surveillance, managing therapeutic interventions and referring the patients and their families for genetic counselling. The aims of this study are to assess the prevalence of HCSS as hereditary leukemia and hematologic malignancy syndrome by using ACMG guidelines and to assess parental consanguinity as the criterion for referring patients for the genetic counselling. Methods: A total of 300 acute lymphoblastic leukemia subjects were recruited from the Children’s Hospital, Lahore, Pakistan during the period of December 2018 to September 2019. Structured self-reporting questionnaire based on family and medical history of the disease was utilized for the data collection.Results: In our cohort, 60.40% of ALL patients were identified to have HCSS and among them 40.65% patients solely fulfil the criteria due to the presence of parental consanguinity. Parental consanguinity was shown to have protective impact on the onset at early age of disease [OD=0.44 (0.25-0.77), p-value= 0.00] while family history of cancer increase the risk of cardiotoxicity [OD= 2.46 (1.15-5.24), p-value=0.02]. Parental consanguinity in the population shows no significant impact on the family history of cancer and the number of relatives with cancer. Conclusions: The higher prevalence of HCSS in Pakistani population is attributed to the presence of parental consanguinity in more than 50% of the patients when assessed through ACMG guidelines. Our study suggests revisiting ACMG guidelines for the criterion of parental consanguinity in the highly consanguineous population and formulating the score based criteria for the identification of inherited ALL for genetic counselling.

Hodgkin’s lymphoma among veterans: Does race matter?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17538-17538
Author(s):  
R. S. Komrokji ◽  
S. F. Mekan ◽  
M. M. Safa ◽  
Z. A. Nahleh ◽  
J. R. Pancoast ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Similar Proportion ◽  
P Value ◽  
Bulky Disease ◽  
Cancer Data ◽  
Medical Centers ◽  
Black Patients ◽  
History Of ◽  
White Patients

17538 Background: Racial disparities in Hodgkin’s lymphoma (HL) are not well studied. Earlier studies suggested that black patients received less treatment and had worse outcome. The VA health care system offers a platform to study those racial differences given similar other variables and socioeconomic status among those patients. Methods: This was a retrospective analysis. The VA Central Cancer Registry (VACCR) database was used to identify patients with HL diagnosed between 1995 and 2005. There are approximately 120 VA medical centers diagnosing and/or treating patients with cancer. Data are entered by tumor registrars at the VA medical centers. This site aggregates the data collected by the medical centers’ cancer registries. Data was extrapolated and analyzed using bio-statistical software SPSS. Results: There were 1009 patients with HL at the VA system, 801 white and 183 black patients. Twenty-five patients from other racial groups were excluded from this analysis. The median age of presentation among blacks was 50.8 years compared to 53.8 years among whites (P-value 0.026). More white patients had family history of HL. Black patients had a higher incidence lymphocyte depleted histological subtype 33 (18.0%) vs. 75 (9.4%) and whites had a higher prevalence of nodular sclerosing subtype, 260 (32.5%) vs. 32 (17.5%). Other baseline characteristics such as sex, history of smoking, alcohol, and radiation exposure were similar. Presence of bulky disease and stage of lymphoma at presentation were also similar. Similar proportion of patients received chemotherapy among the two groups, 70 % for blacks and 69% for whites. Among blacks 19.7 % of patients received radiation while 25.5 % white patients did (P-value 0.24). The 5-year overall survival of blacks was 53 % years as opposed to 54% for whites (P-value 0.93) Conclusions: The presenting features, risk factors are similar across black and white races among VA population. Blacks are more likely to present with lymphocyte depleted type of HD. The treatment and outcome of HL among blacks are not different from whites within the VA system. No significant financial relationships to disclose.

Compliance with germline testing in pancreatic cancer in a rural tertiary care hospital.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10599-10599
Author(s):  
Catherine Travaline ◽  
Leighton Andrew Elliott ◽  
Nadia N. Ramdin ◽  
Joseph Vadakara
Keyword(s):  
Pancreatic Cancer ◽  
Family History ◽  
Pancreatic Adenocarcinoma ◽  
P Value ◽  
Cancer Death ◽  
Nccn Guidelines ◽  
Family History Of Cancer ◽  
History Of ◽  
History Of Cancer ◽  
Germline Testing

10599 Background: Pancreatic cancer is the 7th most common cause of cancer death worldwide and is projected to be the second leading cause of cancer death in the next decade. Personalized care is becoming more of a reality with pharmacological regimens targeting specific genetic mutations. In March 2019, the National Comprehensive Cancer Network (NCCN) guidelines were updated to recommend germline testing (GT) in all patients with pancreatic adenocarcinoma (PDAC) considering 1 in 10 may have a germline mutation (GM). The goal of this study was to quantify compliance with these recently updated guidelines. Methods: The electronic medical records and survivorship data of all patients diagnosed with PDAC between January 1, 2017 and October 1, 2020 were reviewed. April 1, 2019 was used as the transition point (TP) for guideline updates. Descriptive statistics for all variables were determined. The rate of ordered referrals to genetic counseling (GC), as well as completion rate, was calculated. Results: A total of 304 patients were diagnosed with PDAC during the study period (223 prior to the TP). A total of 54 patients were referred for GC and 41 had GT ordered. The rate of GC referrals ordered after the TP was significantly higher than before the TP (22/81, 26.6% vs. 32/223, 14.4%; p-value 0.010). Almost 60% of patients who had genetic evaluation had private insurance. The patients who completed GT were significantly more likely to have a documented family history of cancer (61.0% vs 4.2%; p-value <.0001Patients who completed GT had more problems on their problem list (median 10 vs 7, p = 0.001). The median overall survival (OS) for all patients in the study was 7.8 months (95% CI: 6.3-9.8). Conclusions: Overall compliance with the updated NCCN guidelines significantly improved; however, it was below 25%. This study showed that there may be some lingering bias toward GT in PDAC solely for those who have a family history of cancer. Although patients with stage IV PDAC have poor outcomes, GT may still improve surveillance for family members. The approval of olaparib in patients with BRCA1/2 mutations based on the POLO trial is likely to increase provider compliance as it provides a viable maintenance strategy in these patients. Patient complexity was unlikely to affect GT rate. Assessment of provider awareness was outside the scope of this study. There is need for continued advocacy for awareness and implementation of guidelines that highlight the importance of germline evaluation on prevention, surveillance, and treatment in pancreatic adenocarcinoma.

Investigating the relationship between ccfDNA concentration, its integrity, and some individual factors in an Iranian population

2020 ◽  
Vol 28 (4) ◽  
pp. 319-326
Author(s):  
Maryam Khani ◽  
Jalil Hosseini ◽  
Mohsen Habibi ◽  
Reza Mirfakhraie ◽  
Zahra Sadeghzadeh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Family History ◽  
Individual Factors ◽  
Physiological Status ◽  
P Value ◽  
Statistical Association ◽  
Prostate Hyperplasia ◽  
Family History Of Cancer ◽  
History Of ◽  
History Of Cancer

INTRODUCTION: Circulating cell-free DNA (ccfDNA) increases in some pathologic conditions like cancer. We aimed to investigate the correlation between some individual factors and the ccfDNA level in peripheral blood of Iranian in relation to prostate cancer. MATERIAL AND METHOD: 30 patients with prostate cancer (PCa), 40 with benign prostate hyperplasia (BPH), and 30 controls were studied. Personal information, ccfDNA concentration, and the integrity index were assessed for the correlation between the disease and different factors. The results were statistically analyzed using SPSS software. RESULTS: In PCa group, no association was found between total ccfDNA, BMI, BPH background, non-cancerous diseases, medications, PCa length, and job (p-value > 0.05). But, total ccfDNA had statistical associations with weight, family history of cancer, and location (p-value < 0.05). No association was between the integrity of ccfDNA, weight, the background of BPH, and family history of cancer. But, the integrity of ccfDNA was significantly associated with BMI and PCa length (p-value < 0.05). In BPH group, no association between total ccfDNA or the integrity of ccfDNA and the assessed factors was obtained (p-value > 0.05). In the normal group, neither statistical association was found between total ccfDNA, weight, BMI, and job, nor between the integrity of ccfDNA, weight, BMI, non-cancerous disease, drug, job, and location (p-value > 0.05). But, a statistical association was found between the integrity of ccfDNA and family history of cancer in the recent group (Based on 95% CI and P-value less than 0.05). CONCLUSION: ccfDNA and its integrity as possible prostate cancer biomarkers under the influence of individuals’ physiological status are prone to the pathologic changes toward the disease. Further simultaneous study of the target groups could clarify this matter.

Does race play a role in genetic screening for hereditary cancer syndromes?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1578-1578
Author(s):  
Sudeshna Chatterjee ◽  
Melissa K Frey ◽  
Zhen Ni Zhou ◽  
Ann Carlson ◽  
Thomas A. Caputo ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Family History ◽  
Cancer Center ◽  
Ashkenazi Jews ◽  
Founder Mutations ◽  
Black Patients ◽  
History Of ◽  
Multigene Panels ◽  
History Of Cancer ◽  
White Patients

1578 Background: Molecular analysis of cancer predisposition genes may influence cancer screening, prevention strategies and options for targeted therapy. We sought to identify ethnic differences in patterns of genetic testing. Methods: Results of all patients with known ancestry who underwent genetic testing at the hereditary breast and ovarian cancer center at a single institution between 7/1/2013-12/31/2016 were reviewed. Race was stratified as Black, White, Asian, and Hispanic. Ashkenazi Jews were excluded from the White subgroup because of their higher rates of testing for deleterious founder mutations. White patients were utilized as the reference population for all statistical analysis. Results: 894 patients were included: 139 Black, 613 White, 33 Hispanic and 108 Asian. Black patients were more likely to undergo genetic testing for a personal history of cancer rather than family history risk assessment compared to White patients (p = 0.002). There was no difference in genetic testing rates based on personal or family history of cancer between Asians or Hispanics and Whites (p = 0.398 ;p = 0.366). Black patients were more likely than White patients to undergo testing with targeted-gene rather than multigene panels (p = 0.026). The use of targeted and multigene panels were not different among Asians or Hispanics ( p = 1.0). Blacks, Asians and Hispanics had a lower rate of known deleterious mutations but a higher rate of variants of unknown significance (VUS) than Whites (15.1% p = 0.048; 22.2% p = .001; 33.3%p = .002 respectively). BRCA1/2 mutations accounted for 100% of identified mutations across all the non-White populations. Among Blacks, BRCA1/2 accounted for 38.1% of VUS compared to 27.9% in Whites ( p = .2114). VUS in the ATM gene accounted for 28.6% in Blacks compared to 8.2% in Whites (p = 0.028). Conclusions: Black patients were less likely to undergo testing based on family history, suggesting a missed opportunity for cancer prevention. They were more likely to undergo targeted testing and100% of identified mutations were in BRCA1/2 genes. Non-white patients had higher rates of VUS, emphasizing the need for improved VUS reclassification in non-White populations.

scholarly journals Family history of cancer in first degree relatives and risk of cancer of unknown primary

2021 ◽  
Author(s):  
Alexander L. R. Grewcock ◽  
Karlijn E. P. E. Hermans ◽  
Matty P. Weijenberg ◽  
Piet A. Brandt ◽  
Caroline Loef ◽  
...  
Keyword(s):  
Family History ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
Family History Of Cancer ◽  
First Degree Relatives ◽  
History Of ◽  
Risk Of Cancer ◽  
History Of Cancer

scholarly journals Vitamin D status and risk of type 2 diabetes in the Norwegian HUNT cohort study: does family history or genetic predisposition modify the association?

2021 ◽  
Vol 9 (1) ◽  
pp. e001948
Author(s):  
Marion Denos ◽  
Xiao-Mei Mai ◽  
Bjørn Olav Åsvold ◽  
Elin Pettersen Sørgjerd ◽  
Yue Chen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Family History ◽  
Genetic Predisposition ◽  
Effect Modification ◽  
P Value ◽  
Family History Of Diabetes ◽  
Increased Risk ◽  
History Of

IntroductionWe sought to investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and the risk of type 2 diabetes mellitus (T2DM) in adults who participated in the Trøndelag Health Study (HUNT), and the possible effect modification by family history and genetic predisposition.Research design and methodsThis prospective study included 3574 diabetes-free adults at baseline who participated in the HUNT2 (1995–1997) and HUNT3 (2006–2008) surveys. Serum 25(OH)D levels were determined at baseline and classified as <50 and ≥50 nmol/L. Family history of diabetes was defined as self-reported diabetes among parents and siblings. A Polygenic Risk Score (PRS) for T2DM based on 166 single-nucleotide polymorphisms was generated. Incident T2DM was defined by self-report and/or non-fasting glucose levels greater than 11 mmol/L and serum glutamic acid decarboxylase antibody level of <0.08 antibody index at the follow-up. Multivariable logistic regression models were applied to calculate adjusted ORs with 95% CIs. Effect modification by family history or PRS was assessed by likelihood ratio test (LRT).ResultsOver 11 years of follow-up, 92 (2.6%) participants developed T2DM. A higher risk of incident T2DM was observed in participants with serum 25(OH)D level of<50 nmol/L compared with those of ≥50 nmol/L (OR 1.72, 95% CI 1.03 to 2.86). Level of 25(OH)D<50 nmol/L was associated with an increased risk of T2DM in adults without family history of diabetes (OR 3.87, 95% CI 1.62 to 9.24) but not in those with a family history (OR 0.72, 95% CI 0.32 to 1.62, p value for LRT=0.003). There was no effect modification by PRS (p value for LRT>0.23).ConclusionSerum 25(OH)D<50 nmol/L was associated with an increased risk of T2DM in Norwegian adults. The inverse association was modified by family history of diabetes but not by genetic predisposition to T2DM.

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