Incidence and survival patterns of cutaneous T-cell lymphomas in the United States

BACKGROUND Non-Hodgkin Lymphomas (NHL) represent one of the most common cancers in the United States, accounting for about 4% of all cancers and it is estimated over 77,000 people (including children and adults) will be diagnosed with NHL in the United States in 2020. Depending on the data, it is estimated T-cell lymphomas make up anywhere from 7 to 15% of all NHLs. Given their relative rarity compared to other sub-types of lymphomas (and malignancies at large), there is a scarce literature regarding their outcomes in ethnic minority groups. Retrospective reviews of cancer registries and SEER databases have demonstrated conflicting evidence regarding outcomes in Hispanics (HI) with some studies suggesting worse overall survival (OS) in this group (Clin Lymphoma Myeloma Leuk. PMID: 26198444), while others suggest comparable outcomes in the setting of healthcare homogeneity (Leuk Lymphoma. PMID: 25012944). MATERIALS/METHODS This is a retrospective study of a cohort of patients diagnosed with T-cell NHL from the Texas Cancer Registry (2006-2016). Patients were identified by the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. Data was provided to us completely de-identified. Key variables collected included gender, ethnicity, dates at diagnosis and death, payer, stage, treatment, and poverty index. Categorical outcomes were summarized with frequencies and percentages and age, the only continuously distributed outcome, with the mean and standard deviation. The significance of variation in distribution of categorical outcomes with ethnicity [HI, non-Hispanic (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. 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 was used throughout. RESULTS We identified 2074 patients with T-cell NHL (n= 902 Peripheral T Cell, NOS; 295 Angioimmunoblastic T Cell; 577 Anaplastic Large T Cell; 120 NK/T-cell; and 180 Adult T-cell Leukemia/Lymphoma). 553 were HI (26%), 1521 NH (74%). Median age of diagnosis in HI was 50.1 vs 57.4 in NH (p = <0.001). Males were more frequently affected, 63.8% in HI vs 58.9% in NH (p = 0.048). Most frequent poverty index was 20-100% for HI vs 10-19.9% for NH (p < 0.001). Most frequent payor for both groups were Medicare with 24.3% in HI vs 35.3% in NH (p < 0.001). Most common stage at diagnosis in both groups was III/IV with 50.3% in HI vs 49.7% in NH (p = 0.031). Most frequent chemotherapy included multiple agents for both, 55.7% in HI vs 44.2% in NH (p < 0.001). Majority in both groups had neither hematologic transplant 90.2% in HI vs 85.3% in NH (p = 0.073) nor radiation, 84.4% in HI vs 82.9% in NH (p = 0.076). Median overall survival (OS) in HI was 1.7 years vs 1.9 in NH; survival probability for HI vs NH at 2 years was 0.46 vs 0.49, at 5 years 0.37 vs 0.35, and at 10 years 0.24 vs 0.23 with no statistically significant difference in OS probability (p=0.89). CONCLUSION Our study demonstrates that amongst the population of Texas, HI with T-cell NHL have similar outcomes when compared to their NH counterparts. Breakdown of our cohort demonstrated similar healthcare utilization, as well as diagnostic and treatment modalities amongst both groups. Within the context of healthcare equality, we ascertained similar outcomes amongst groups, which is in agreement with previous reports claiming homogeneity of medical care helps overcome ethnic disparities. Figure Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

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Comparative Analysis of Mature T-Cell and NK/T-Cell Lymphomas in Patients with and without HIV: Results from the NA-Accord and Complete Cohorts

Blood ◽

10.1182/blood-2021-147837 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1380-1380

Author(s):

Min Jung Koh ◽

Mwanasha H. Merrill ◽

Min Ji Koh ◽

Robert N. Stuver ◽

Carolyn D. Alonso ◽

...

Keyword(s):

United States ◽

T Cell ◽

Research Funding ◽

Cell Lymphoma ◽

Burkitt’S Lymphoma ◽

The United States ◽

Burkitt's Lymphoma ◽

Peripheral T Cell Lymphoma ◽

T Cell Lymphomas

Abstract Background: Clinicopathological characteristics and prognosis for patients with HIV (PWH) and T-cell lymphomas (TCLs) in the current antiretroviral therapy (ART) era remains unknown. The primary objective of this study was to determine outcomes of patients with mature T and NK/T-cell lymphomas with and without HIV (PWoH) in North America. A secondary objective was to define variations in the survival of patients with TCLs and AIDS-defining B-cell lymphomas (A-BCLs) in the presence of ART. Methods: The study population included patients from two source populations, the NA-ACCORD (The North American AIDS Cohort Collaboration on Research and Design) and COMPLETE (Comprehensive Oncology Measures for Peripheral T-cell Lymphoma), both of which have been previously described. The NA-ACCORD collaborates with >20 longitudinal cohorts of adults (aged ≥ 18 years) with HIV in the United States and Canada. Within the NA-ACCORD cohort, we included patients with a validated incidental diagnosis of mature T and NK/TCL (n=52) or the most common A-BCLs including Burkitt's lymphoma (n=101), diffuse large B-cell lymphoma (DLBCL, n=500) and primary CNS lymphoma (PCNSL, n=64) between 1996 and 2016. COMPLETE is a prospective, multicenter cohort study of patients with newly diagnosed incidental mature TCLs in the United States between 2010 and 2014. Of the 452 eligible patients, 450 were included for analysis after exclusion of two patients with HIV infection. Patients were followed from diagnosis to the first of death, loss to follow-up or administrative censoring at 5 years. Kaplan-Meier and log-rank tests were used to estimate and compare survival. Results: At the time of TCL diagnosis, PWH were significantly younger than patients without HIV (PWoH) (49 years vs. 60 years respectively; p<0.001). PWH were predominantly men (96% vs. 63%; p<0.001), of white race (64% vs. 77%; p<0.006), with chronic kidney disease (19% vs. 2.2%; p<0.001) and with co-infections such as hepatitis B virus (13% vs. 0.9%; p<0.001) and hepatitis C virus (19% vs. 1.1%; p<0.001). Anaplastic large-cell lymphoma (ALCL, n=26) was the most common histological subtype within PWH relative to peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS, n=143) among PWoH. More than 92% of the patients within the NA-ACCORD cohort were on at least one class of ART during their cohort enrollment period. Median duration of ART prior to lymphoma diagnosis was 2.9 years (0.7-9.4) and comparable for patients with TCLs and A-BCLs. The median time from NA-ACCORD cohort enrollment to lymphoma diagnosis was 2.3 years (IQR: 0.3-5.9 years) for TCLs and comparable for patients with the A-BCL subgroups (2.8 years, IQR: 0.6-7.2 years; p=0.21). At the end of the 5-year follow-up period, the survival probability since TCL diagnosis was markedly lower at 0.32 (95% confidence interval [CI]: 0.21-0.49) among PWH in contrast to 0.45 (95% CI: 0.41-0.51) for PWoH. Specifically, survival probability since ALCL diagnosis was distinctively lower at 0.23 (95% CI: 0.11-0.47) among PWH in contrast to 0.76 (95% CI: 0.66-0.87) for PWoH. Mortality following lymphoma diagnosis was elevated for PWH vs. PWoH even after adjusting for statistically significant baseline clinical characteristics such as age, race, and ALCL status in multivariate analysis (adjusted HR: 1.92; 95% CI: 1.27, 2.91). Among PWH with TCL, CD4 <200 and viral load (VL) >500 (n=10) was associated with a lower survival relative to those with counts >200 and/or VL <500 (n=12, p=0.031). Upon stratification of PWH into different calendar periods based on year of diagnosis (1996-1999 vs. 2000-2009 vs. 2010-2016), we observed an improvement in survival for all subgroups over time. Overall, among PWH, PCNSL had the worst median overall survival (3.8 months, 95% Cl: 2.0-7.2 months) followed by ALCL (10.6 months, 95% Cl: 2.1-33.4 months), DLBCL (15.6 months, 95% CI: 12.7-22.2 months) and Burkitt's lymphoma. Conclusions: Our report based on two large observational cohorts in North America highlights poor outcomes for TCLs among PWH compared to PWoH. In addition, within the PWH group, our study is the first to delineate inferior survival for patients with ALCLs relative to DLBCL and Burkitt's lymphoma accentuating the need for novel therapies. However, the overall prognosis for these lymphomas among PWH has improved in the last two decades, particularly among those with CD4>200, underscoring the impact of early and sustained ART. Disclosures Alonso: Merck: Research Funding. Foss: Kyowa: Honoraria; Acrotech: Honoraria, Speakers Bureau; Seattle Genetics: Honoraria, Speakers Bureau; Mallinckrodt: Honoraria; Daiichi Sankyo: Honoraria; Kura: Honoraria. Jain: Trillium Therapeutics, Inc: Research Funding; Acro Biotech, Inc: Research Funding; Abcuro, Inc: Research Funding.

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