Socioeconomic Inequalities in Treatment and Relative Survival Among Patients With Diffuse Large B-Cell Lymphoma in Hong Kong

2020 ◽  
Author(s):  
Shing Fung Lee ◽  
Andrew M. Evens ◽  
Andrea K. Ng ◽  
Miguel Angel Luque-Fernandez
Keyword(s):  
Hong Kong ◽  
B Cell ◽  
Cell Lymphoma ◽  
Relative Survival ◽  
B Cell Lymphoma ◽  
Socioeconomic Inequalities ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Socioeconomic Inequalities in Treatment and Relative Survival Among Patients with Diffuse Large B-Cell Lymphoma: A Hong Kong Population-Based Study

2021 ◽  
Author(s):  
Shing Fung Lee ◽  
Andrew Evens ◽  
Andrea Ng ◽  
Miguel-Angel Luque-Fernandez
Keyword(s):  
Hong Kong ◽  
Excess Mortality ◽  
Cell Lymphoma ◽  
Relative Survival ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Secular Trends ◽  
Low Ses ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract The influence of socioeconomic status (SES) on access to standard chemotherapy and/or monoclonal antibody therapy, and associated secular trends, relative survival, and excess mortality, among diffuse large B-cell lymphoma (DLBCL) patients is not clear. We conducted a Hong Kong population-based cohort study and identified adult patients with histologically diagnosed DLBCL between 2000 and 2018. We examined the association of SES levels with the odds and the secular trends of receipt of chemotherapy and/or rituximab. Additionally, we estimated the long-term relative survival by SES utilizing Hong Kong life tables. Among 4,017 patients with DLBCL, 2,363 (58.8%) patients received both chemotherapy and rituximab and 740 (18.4%) patients received chemotherapy alone, while 1,612 (40.1%) and 914 (22.8%) patients received no rituximab or chemotherapy, respectively. On multivariable analysis, low SES was associated with lesser use of chemotherapy (odd ratio [OR], 0.44; 95% CI 0.34–0.57) and rituximab (OR, 0.41; 95% CI, 0.32–0.52). The socioeconomic disparity for either treatment showed no secular trend of change. Additionally, patients with low SES showed increased excess mortality, with a hazard ratio of 2.34 (95% CI, 1.67–3.28). Improving survival outcomes for patients with DLBCL requires provision of best available medical care and securing access to treatment regardless of patients’ SES.

Disparities In Receipt Of Radiotherapy and Survival By Age, Sex and Ethnicity Among Patients With Localized Diffuse Large B-Cell Lymphoma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 558-558
Author(s):  
Binay K. Shah ◽  
Amir Bista
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
Relative Survival ◽  
B Cell Lymphoma ◽  
Population Based ◽  
P Value ◽  
Large B Cell Lymphoma ◽  
To Receive ◽  
Large B Cell

Abstract Background Combination therapy with 3 cycles of chemotherapy followed by involved field radiotherapy has been a standard of care for treatment of localized diffuse large B-cell lymphoma (Miller TP NEJM 1998). This population based study evaluated ethnic disparities in receipt of radiotherapy (RT) and its effect on survival in patients with localized diffuse large B cell lymphoma (DLBCL) in the United States. Methods The Surveillance, Epidemiology, and End Results database was reviewed to identify patients with stage I DLBCL diagnosed between 1998 and 2008. We used unadjusted and adjusted odds ratio (OR) to analyze association of receipt of radiotherapy with age (<60 and 60+ years), sex and ethnicity (White, Black and Others). We calculated relative survival rates for different cohorts using SEER*Stat software. We used cox’s proportional hazard model to investigate the impact of age, sex and ethnicity on survival rates. Results A total of 11763 patients with localized DLBCL as the only primary malignancy were included in the study. Of the cohort, 38.2% received radiotherapy. Receipt of radiotherapy varied significantly by patient ethnicity - whites were more likely to receive RT compared to blacks and others. Similarly, age <60 years and females were more likely to receive radiotherapy compared with older patients and males (Table – 1). The 1- and 5- year relative survival rates for patients receiving RT were higher compared to those who did not receive RT: 88.3±0.5% vs 73.4±0.6%, p-value <0.0001 at 1-year and 77.8±0.8% vs 62.5±0.7%, p-value <0.0001 at 5-years. Among patients who received RT, 1- and 5- year relative survival rates were significantly higher in whites compared to black or other- race patients. Conclusions This population based study showed that only 38.2% of patients with localized DLBCL received radiotherapy. White patients were more likely to receive RT compared to blacks and others. Survival rates are significantly higher for patients who received RT. Disclosures: No relevant conflicts of interest to declare.

Survival In Advanced Diffuse Large B-Cell Lymphoma In Pre- and Post-Rituximab Eras In The United States: A Population Based Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1747-1747
Author(s):  
Amir Bista ◽  
Bahman Shafii ◽  
Binay K. Shah
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
Relative Survival ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Young Males ◽  
Large B Cell Lymphoma ◽  
One Year ◽  
Large B Cell

Abstract Background Rituximab was approved by FDA as first line agent for treatment of advanced diffuse large B-cell lymphoma (DLBCL) on February 2006. We conducted this population based study to determine if the results from clinical trials have translated into survival benefit in general population. Methods We selected patients with advanced diffuse large B cell lymphoma (Distant stage based on LRD Summary Staging 1998+ in SEER*Stat) from Surveillance, Epidemiology, and End Results (SEER) 18 database (1973-2010), and calculated relative survival rates for patients diagnosed from 2002-2005(pre-rituximab) and March 2006 to 2009 (post-rituximab). We used Z-test in the SEER*Stat to compare the relative survival rates in cohorts categorized by race (white, black and other), gender, and age groups (<60 and 60+). The “Cansurv” software, and specifically, Cox proportional hazard function were used to investigate the influence of age (<60 ; 60+ years), sex (male; female), race (white; black; others) and marital status (married; single; separated/divorced/widowed) on the relative survival. Results A total of 15627 patients with advanced stage DLBCL as the only primary cancer were identified. Patients were predominantly white of non-Hispanic, non-Spanish/non-Latino origin, males, belonging to the older age category and married. The median age at the diagnosis was 65 years. One-year relative survival in ‘Whites’ and ‘Others’ improved significantly in post-rituximab era compared to pre-rituximab era (64.80 ± 0.6% vs 61.3 ± 0.6%; p= 0.0002 and 64.5 ± 1.9% vs 54.9 ± 2.2%; p= 0.0011, respectively). Also, three year relative survival improved significantly in ‘Whites’ and ‘Others’ in post-rituximab era compared to pre-rituximab era (53.7 ± 0.7% vs 50.3 ± 0.7%; p= 0.0001 and 52.0 ± 2.3% vs 40.8 ± 2.3%; p= 0.0002, respectively). However, no significant improvement were observed in one-year and three-year relative survival in blacks, during post rituximab era comapared to pre-rituximab era. Interestingly, in pre-rituximab era, relative survival in blacks was comparable to that of whites, but it was significantly better than that of others (p<.05). Although there was significant improvement in one- and three-year relative survival in young females, old males and old females, no significant improvement (p>.05) in survival was observed in the young males. Factors such as young age, female sex, non-Hispanic origin, white race, married status and post-rituximab era were associated with significantly better survival (p<.05). Conclusion The relative survival rates among young males and black patients with advanced diffuse large B cell lymphoma has not improved during post-rituximab era. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Socioeconomic inequalities in treatment and relative survival among patients with diffuse large B-cell lymphoma: a Hong Kong population-based study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shing Fung Lee ◽  
Andrew M. Evens ◽  
Andrea K. Ng ◽  
Miguel-Angel Luque-Fernandez
Keyword(s):  
Hong Kong ◽  
Excess Mortality ◽  
Cell Lymphoma ◽  
Relative Survival ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Secular Trends ◽  
Low Ses ◽  
Large B Cell Lymphoma ◽  
Large B Cell

AbstractThe influence of socioeconomic status (SES) on access to standard chemotherapy and/or monoclonal antibody therapy, and associated secular trends, relative survival, and excess mortality, among diffuse large B-cell lymphoma (DLBCL) patients is not clear. We conducted a Hong Kong population-based cohort study and identified adult patients with histologically diagnosed DLBCL between 2000 and 2018. We examined the association of SES levels with the odds and the secular trends of receipt of chemotherapy and/or rituximab. Additionally, we estimated the long-term relative survival by SES utilizing Hong Kong life tables. Among 4017 patients with DLBCL, 2363 (58.8%) patients received both chemotherapy and rituximab and 740 (18.4%) patients received chemotherapy alone, while 1612 (40.1%) and 914 (22.8%) patients received no rituximab or chemotherapy, respectively. On multivariable analysis, low SES was associated with lesser use of chemotherapy (odd ratio [OR] 0.44; 95% CI 0.34–0.57) and rituximab (OR 0.41; 95% CI 0.32–0.52). The socioeconomic disparity for either treatment showed no secular trend of change. Additionally, patients with low SES showed increased excess mortality, with a hazard ratio of 2.34 (95% CI 1.67–3.28). Improving survival outcomes for patients with DLBCL requires provision of best available medical care and securing access to treatment regardless of patients’ SES.

scholarly journals Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?

Haematologica ◽  
2016 ◽  
Vol 102 (3) ◽  
pp. 584-592 ◽  
Author(s):  
Sandra Le Guyader-Peyrou ◽  
Sébastien Orazio ◽  
Olivier Dejardin ◽  
Marc Maynadié ◽  
Xavier Troussard ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Economic Status ◽  
Relative Survival ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Population Based Study ◽  
Socio Economic Status ◽  
Large B Cell Lymphoma ◽  
Large B Cell

scholarly journals Doxorubicin and subsequent risk of cardiovascular diseases among survivors of diffuse large B-cell lymphoma in Hong Kong

2020 ◽  
Vol 4 (20) ◽  
pp. 5107-5117
Author(s):  
Shing Fung Lee ◽  
Miguel Angel Luque-Fernandez ◽  
Yu Hui Chen ◽  
Paul J. Catalano ◽  
Chi Leung Chiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hong Kong ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
B Cell ◽  
Cardiovascular Risk Factors ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Evidence regarding the dose-related impact of doxorubicin on subsequent cardiovascular diseases (CVDs) in Asian patients with diffuse large B-cell lymphoma (DLBCL) without preexisting CVDs is lacking. From a territory-wide electronic database in Hong Kong, we identified adults who were diagnosed with DLBCL and treated with chemotherapy between 2000 and 2018. We evaluated the patients for incident CVDs (including ischemic heart disease, heart failure, and cardiomyopathy). We evaluated the cause-specific cumulative incidence (csCI) of CVD with levels of doxorubicin exposure by using flexible parametric competing risk analysis and adjusting for demographics, comorbidities, therapeutic exposure, cardiovascular risk factors, and lifestyle factors. Controls were age- and sex-matched to DLBCL patients. We analyzed 2600 patients and 13 000 controls. The adjusted cause-specific hazard ratio (HR) for CVD in patients treated with &gt;500 mg doxorubicin compared with non-doxorubicin regimens was 2.65 (95% confidence interval [CI], 1.23-5.74; P = .013). The 5-, 10-, and 15-year csCIs were 8.2%, 11.3%, and 12.8% in patients vs 3.1%, 4.4%, and 5.2% in controls, respectively. Hypertension (HR, 6.20; 95% CI, 0.79-48.44; P = .082) and use of aspirin/angiotensin-converting enzyme inhibitor/beta-blocker at baseline (HR, 2.13-4.63; P &lt; .001 to .002) might confer a higher risk of subsequent CVDs. In this Hong Kong population-based study, doxorubicin exposure (absolute dose &gt;500 mg), together with hypertension or baseline use of medication for cardiovascular risk factors, was found to be associated with an increase in csCIs of CVDs. Tailoring therapeutic strategies to underlying CVD risk factors and risk-adapted monitoring and follow-up of susceptible DLBCL patients are advisable.

scholarly journals Survival Trends Among Very Elderly Patients with Advanced Diffuse Large B-Cell Lymphoma - a Population Based Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2640-2640
Author(s):  
Binay K. Shah ◽  
Krishna B Ghimire ◽  
Dinesh Pendharkar
Keyword(s):  
Elderly Patients ◽  
B Cell ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
Relative Survival ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Very Elderly ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background Rituximab became commercially available in Novermber 1997. It was FDA approved in February 2006 for the first line treatment of patients with advanced diffuse large B cell lymphoma (DLBCL). The incidence of diffuse large B cell lymphoma increases with age, with >100 cases per 100000 persons aged >80 years. There is a limited data on survival very elderly patients with DLBCL. This study was conducted to evaluate survival trends of very elderly (≥80 years) patients with advanced DLBCL in the United States. Methods We selected very elderly patients (age ≥80 years) diagnosed with Stage III and IV DLBCL from the Surveillance, Epidemiology, and End Results (SEER) 18 database. We calculated 1- and 2- year relative survival rates of the patients during 1992-1997 (Pre-rituximab era) and 1998-2009 (post –rituximab era). We also analyzed survival rates of patients diagnosed before (1998 – 2005) and after (2006-2009) FDA approval of rituximab for the first line treatment of DLBCL. We used SEER Stat software to calculate relative survival (RS) rates. Results There were 2709 advanced DLBCL patients reported during 1992-2009. Overall median survival of the group was 6±0.240 months. The 1- and 2- year relative survival rates of the patients improved significantly from pre-rituximab era to post-rituximab era (1 year RS: 30±2.0 vs 38.9±1.2; Z value 4.16 and 2 year RS: 19.7±1.8 vs 32.8±1.2; Z 5.16). The survival rates were higher in the post-rituximab era for all the cohorts except the Blacks and Others. However, there was no difference in the survival rates of the patients diagnosed during 2006-2009 compared to those diagnosed during 1998-2005 (Table). Conclusion Our population based study showed that the survival rates of very elderly patients with advanced DLBCL have improved in the post-rituximab era for all groups except the Blacks and Others. There is no significant improvement in survival of patients before- and after approval of rituximab in the post-rituximab era. Abstract 2640. Table: Advanced DLBCL relative survival rates in elderly (age ≥ 80 years) Cohorts Survival 1992-1997 1998-2009 1998-2005 2006-2009 Z value (92-97 vs 98-09) Zvalue (98-05 vs 06-09) N RS ± SE% N RS ± SE% N RS ±SE % N RS ± SE% Male & Female 12 mo 633 30±2.0 2,076 38.9±1.2 1,274 38.1±1.5 802 40.1±1.9 4.159 0.796 24 mo 19.7±1.8 2,076 32.8±1.2 31.2±1.5 35.3±1.9 5.162 1.166 Male 12 mo 263 30.6±3.1 950 39.7±1.7 583 38.3±2.2 367 41.0±2.8 2.798 0.632 24 mo 18.6±2.7 950 33.7±1.8 30.6±2.2 38.4±3.0 3.750 1.304 Female 12 mo 370 29.5±2.5 1,126 38.2±1.5 691 37.4±2.0 435 39.4±2.5 3.036 0.478 24 mo 20.4±2.3 1,126 32.1±1.6 31.7±2.0 32.7±2.5 3.620 0.335 White 12 mo 572 29.8±2.0 1,786 39.8±1.3 1,101 38.5±1.6 685 41.8±2.0 4.145 1.106 24 mo 19.9±1.9 1,786 33.7±1.3 32.0±1.6 36.4±2.1 5.029 1.266 Black 12 mo 20 21.0±9.4 77 27.0±5.4 46 30.9±7.3 31 21.2±7.8 1.499 -1.030 24 mo 17.3±9.2 77 23.6±5.5 25.1±7.0 19.5±8.0 1.476 -0.894 Other 12 mo 41 36.1±7.8 211 35.4±3.5 126 36.3±4.5 85 34.1±5.4 0.349 0.029 24 mo 16.7±6.3 211 28.1±3.4 25.4±4.1 31.7±5.4 1.114 0.631 N: Number of patients Disclosures No relevant conflicts of interest to declare.

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