Excess Mortality by Multimorbidity, Socioeconomic, and Healthcare Factors, amongst Patients Diagnosed with Diffuse Large B-Cell or Follicular Lymphoma in England

(1) Background: Socioeconomic inequalities of survival in patients with lymphoma persist, which may be explained by patients’ comorbidities. We aimed to assess the association between comorbidities and the survival of patients diagnosed with diffuse large B-cell (DLBCL) or follicular lymphoma (FL) in England accounting for other socio-demographic characteristics. (2) Methods: Population-based cancer registry data were linked to Hospital Episode Statistics. We used a flexible multilevel excess hazard model to estimate excess mortality and net survival by patient’s comorbidity status, adjusted for sociodemographic, economic, and healthcare factors, and accounting for the patient’s area of residence. We used the latent normal joint modelling multiple imputation approach for missing data. (3) Results: Overall, 15,516 and 29,898 patients were diagnosed with FL and DLBCL in England between 2005 and 2013, respectively. Amongst DLBCL and FL patients, respectively, those in the most deprived areas showed 1.22 (95% confidence interval (CI): 1.18–1.27) and 1.45 (95% CI: 1.30–1.62) times higher excess mortality hazard compared to those in the least deprived areas, adjusted for comorbidity status, age at diagnosis, sex, ethnicity, and route to diagnosis. (4) Conclusions: Deprivation is consistently associated with poorer survival among patients diagnosed with DLBCL or FL, after adjusting for co/multimorbidities. Comorbidities and multimorbidities need to be considered when planning public health interventions targeting haematological malignancies in England.

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Excess mortality by patient’s multimorbidity, socioeconomic, and healthcare factors, among Diffuse Large B–cell and Follicular lymphomas patients in England: A population-based multilevel study

10.21203/rs.3.rs-209668/v1 ◽

2021 ◽

Author(s):

Matthew J. Smith ◽

Aurélien Belot ◽

Matteo Quartagno ◽

Miguel Angel Luque-Fernandez ◽

Audrey Bonaventure ◽

...

Keyword(s):

B Cell ◽

Excess Mortality ◽

Population Based ◽

Health Interventions ◽

Non Hodgkin Lymphoma ◽

Cancer Registry Data ◽

Follicular Lymphomas ◽

Comorbidity Status ◽

Large B Cell ◽

Deprived Areas

Abstract Background Socioeconomic inequalities of survival in patients with non–Hodgkin lymphoma (NHL) persists, which may be explained by patients’ comorbidities. We aimed to assess the association between co/multimorbidity and survival in patients diagnosed with Diffuse Large B-cell (DLBCL) or Follicular lymphoma (FL) in England accounting for other socio-demographic characteristics. Methods Population-based cancer registry data was linked to Hospital Episode Statistics. We used a flexible multilevel excess hazard model to estimate 5–year net survival and excess mortality by patient’s multimorbidity and comorbidity status adjusted for sociodemographic, economic, healthcare factors, and accounting for the patient’s area of residence. Results Overall, 15,516 and 29,898 patients were diagnosed with FL and DLBCL in England between 2005–2013, respectively. Respectively, those with comorbidities and multimorbidities had 1.3 (95% Confidence Interval -CI-: 1.20–1.40) and 1.5 (95% CI 1.27–1.87) times higher excess mortality compared to those without comorbidities. Patients in most deprived areas showed 26% (95% CI 1.20–1.32) excess mortality risk compared to those in least deprived areas. Conclusion Co/multimorbidities are consistently associated with poorer survival among patients diagnosed with DLBCL or FL. Comorbidities and multimorbidity need to be considered when planning public health interventions targeting haematological malignancies in England.

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Changes in dynamics of excess mortality rates and net survival after diagnosis of follicular lymphoma or diffuse large B-cell lymphoma: comparison between European population-based data (EUROCARE-5)

The Lancet Haematology ◽

10.1016/s2352-3026(15)00155-6 ◽

2015 ◽

Vol 2 (11) ◽

pp. e481-e491 ◽

Cited By ~ 19

Author(s):

Morgane Mounier ◽

Nadine Bossard ◽

Laurent Remontet ◽

Aurélien Belot ◽

Pamela Minicozzi ◽

...

Keyword(s):

Follicular Lymphoma ◽

B Cell ◽

Excess Mortality ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Mortality Rates ◽

Population Based ◽

European Population ◽

Large B Cell Lymphoma ◽

Large B Cell

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Association between multimorbidity and socioeconomic deprivation on short-term mortality among patients with diffuse large B-cell or follicular lymphoma in England: a nationwide cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049087 ◽

2021 ◽

Vol 11 (11) ◽

pp. e049087

Author(s):

Matthew James Smith ◽

Edmund Njeru Njagi ◽

Aurelien Belot ◽

Clémence Leyrat ◽

Audrey Bonaventure ◽

...

Keyword(s):

Follicular Lymphoma ◽

B Cell ◽

Mortality Risk ◽

Population Based ◽

Socioeconomic Deprivation ◽

Short Term ◽

English Population ◽

Short Term Mortality ◽

Rate Ratios ◽

Large B Cell

ObjectivesWe aimed to assess the association between multimorbidity and deprivation on short-term mortality among patients with diffuse large B-cell (DLBCL) and follicular lymphoma (FL) in England.SettingThe association of multimorbidity and socioeconomic deprivation on survival among patients diagnosed with DLBCL and FL in England between 2005 and 2013. We linked the English population-based cancer registry with electronic health records databases and estimated adjusted mortality rate ratios by multimorbidity and deprivation status. Using flexible hazard-based regression models, we computed DLBCL and FL standardised mortality risk by deprivation and multimorbidity at 1 year.ResultsOverall, 41 422 patients aged 45–99 years were diagnosed with DLBCL or FL in England during 2005–2015. Most deprived patients with FL with multimorbidities had three times higher hazard of 1-year mortality (HR: 3.3, CI 2.48 to 4.28, p<0.001) than least deprived patients without comorbidity; among DLBCL, there was approximately twice the hazard (HR: 1.9, CI 1.70 to 2.07, p<0.001).ConclusionsMultimorbidity, deprivation and their combination are strong and independent predictors of an increased short-term mortality risk among patients with DLBCL and FL in England. Public health measures targeting the reduction of multimorbidity among most deprived patients with DLBCL and FL are needed to reduce the short-term mortality gap.

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Rituximab use and survival after diffuse large B-cell or follicular lymphoma: a population-based study

Leukemia & Lymphoma ◽

10.3109/10428194.2012.727415 ◽

2012 ◽

Vol 54 (4) ◽

pp. 743-751 ◽

Cited By ~ 9

Author(s):

Theresa H. M. Keegan ◽

Lisa M. Moy ◽

James M. Foran ◽

Ash A. Alizadeh ◽

Ellen T. Chang ◽

...

Keyword(s):

Follicular Lymphoma ◽

B Cell ◽

Population Based ◽

Population Based Study ◽

Large B Cell

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Transformation of follicular lymphoma to diffuse large B-cell lymphoma proceeds by distinct oncogenic mechanisms

Yearbook of Pathology and Laboratory Medicine ◽

10.1016/s1077-9108(08)70699-6 ◽

2008 ◽

Vol 2008 ◽

pp. 270-271

Author(s):

M. Djokic

Keyword(s):

Follicular Lymphoma ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Incidence of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) including CNS relapse in a population-based cohort of 4243 patients in Sweden

Blood Cancer Journal ◽

10.1038/s41408-020-00403-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sara Harrysson ◽

Sandra Eloranta ◽

Sara Ekberg ◽

Gunilla Enblad ◽

Mats Jerkeman ◽

...

Keyword(s):

B Cell ◽

Cumulative Incidence ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Population Based ◽

Refractory Disease ◽

Curative Intent ◽

Large B Cell Lymphoma ◽

Cns Relapse ◽

Large B Cell

AbstractWe performed a national population-based study of all patients diagnosed with diffuse large B-cell lymphoma (DLBCL) in Sweden in 2007–2014 to assess treatment intent and risk of relapsed/refractory disease, including central nervous system (CNS) relapse, in the presence of competing risks. Overall, 84% of patients started treatment with curative intent (anthracycline-based) (n = 3550, median age 69 years), whereas 14% did not (n = 594, median age 84 years) (for 2% the intent was uncertain). Patients treated with curative intent had a 5-year OS of 65.3% (95% CI: 63.7–66.9). The median OS among non-curatively treated patients was 2.9 months. The 5-year cumulative incidence of relapsed/refractory disease in curative patients was 23.1% (95% CI: 21.7–24.6, n = 847). The 2-year cumulative incidence of CNS relapse was 3.0% (95% CI: 2.5–3.6, n = 118) overall, and 8.0% (95% CI: 6.0–10.6, n = 48) among patients with high CNS-IPI (4–6), when considering other relapse locations and death as competing events. The incidence of relapsed/refractory DLBCL overall and in the CNS was lower than in previous reports, still one in seven patients was not considered fit enough to start standard immunochemotherapy at diagnosis. These results are important for quantification of groups of DLBCL patients with poor prognosis requiring completely different types of interventions.

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

10.21203/rs.3.rs-145982/v1 ◽

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.

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Trends in Utilization of Intensity Modulated Radiotherapy in Diffuse Large B-cell Lymphoma in the U.S. From 2001 to 2005: A Population-based Study

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2011.06.1067 ◽

2011 ◽

Vol 81 (2) ◽

pp. S571

Author(s):

L. Ballas ◽

P. I-Wen ◽

B.A. Guadagnolo ◽

B.D. Smith ◽

T.A. Buchholz ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

Intensity Modulated Radiotherapy ◽

B Cell Lymphoma ◽

Population Based ◽

Population Based Study ◽

Intensity Modulated ◽

Large B Cell Lymphoma ◽

The U.S ◽

Large B Cell

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New nomograms based on treatment outcome and prognostic factors for patients with spinal diffuse large B-cell lymphoma: A population‐based study

10.21203/rs.2.20787/v1 ◽

2020 ◽

Author(s):

Ben Wang ◽

Lijie Chen ◽

Boda Chen ◽

Chenglong Xie ◽

Zhenxuan Shao ◽

...

Keyword(s):

Prognostic Factors ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Treatment Method ◽

Population Based ◽

Cancer Specific Survival ◽

Internal Validation ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Background: Spinal diffuse large B-cell lymphoma (DLBCL) was a rare and malignant tumor, while few studies researched the prognostic factors. The prognostic factors which might have impacts on spinal DLBCL was not clear. Although chemotherapy was recognized as an optimal treatment method, but the curative effect of radiotherapy and surgery were controversial. Methods: The records of patients with spinal DLBCL were selected from the SEER database from 1991 to 2016. The incidence obtained by database was analyzed by Joinpoint Regression Program. The optimal cut-off values of age and year of diagnosis were identified by X-tail program. Univariate and multivariate survival analysis were calculated to identify independent prognostic factors. Prognostic factors were included to predict the survival possibility compared with 5 years of overall (OS) and cancer-specific survival (CSS) via the new nomograms. Results: A total of 917 patients were enrolled. Age, year of diagnosis and chemotherapy were demonstrated as independent prognostic factors for CSS and OS, and primary site was another independent prognostic factor for CSS. However, radiotherapy and surgery might be ineffective in survival. All factors were included to generate the nomograms for CSS and OS. The concordance indices (C-index) for internal validation of OS and CSS prediction were 0.697 (95%CI: 0.662-0.732) and 0.709 (95%CI: 0.692- 0.727) respectively. Conclusions: Age and year of diagnosis are closely associated with the prognosis of spinal DLBCL, and chemotherapy is an ideal treatment modality. The new nomogram is a favourable tool to evaluate the survival possibility, and is benefit for the oncologist to make clinical decisions.

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