Objectives: This study aims to characterize the epidemiology of immunocompetent Primary central nervous system lymphoma (PCNSL) diagnosed 2000-2013 in Sweden.Methods: Cases were identified in the population-based Swedish Lymphoma Register.Incidence per 100 000 person-years and 95% confidence intervals (CI) were calculated, and PCNSL-specific survival was estimated using relative survival. Tests for temporal trends were performed using Poisson regression. Population incidence of all brain tumors was retrieved for comparison.Results: With 359 identified PCNSL cases (median age 66 years), overall incidence was 0.26 (95% CI: 0.24-0.29) and the average annual increase 4% (P = .002). The increasing trend was primarily observed among elderly individuals (70+ years). Similarly, an increase in incidence of all brain tumors was noted only among the elderly. There was no significant improvement in relative survival across the study period although, among fit patients (with Eastern Cooperative Oncology Group, EGOC 0), survival plateaued 6 years after diagnosis. Conclusion:The increasing PCNSL incidence in the elderly was consistent with an increasing incidence of brain tumors of any type and may in part be attributable to improved diagnostics and reporting in this group. New treatment options have not yet translated into general survival improvements in a population-based setting, although the presence of long-term survivors among fit patients is encouraging. K E Y W O R D Scentral nervous system neoplasms, epidemiology, incidence, lymphoma, survival
The magnitude of risk associated with 9/10 mismatched unrelated donor (MMURD) hematopoietic stem cell transplantation and that of mismatches at the individual HLA loci remain unclear. We performed a metaanalysis to assess the difference in clinical outcomes between matched unrelated donor (MUD) and MMURD transplantation. A comprehensive search of Medline and Embase for manuscripts regarding transplantation outcomes in primarily adult patients with hematologic malignancies was performed. The pooled effect estimates were calculated using DerSimonian-Laird random effects models. A total of 13 studies were included, reporting on 13,446 transplants. 9/10 MMURD transplantation was associated with worse overall survival compared to 10/10 MUD transplantation (pooled HR: 1.27, 95% CI: 1.12-1.45; n 5 7 studies). Mismatch at HLA-A, -B, or -C was associated with significantly worse overall survival compared to MUD transplantation, while there was no significant difference associated with -DQ or -DPB1 mismatch. Inferior survival associated with HLA-DRB1 mismatch could not be ruled out. Data on acute and chronic graft-versus-host disease were scarce but favored MUD transplantation. In summary, this meta-analysis of the available literature favored MUD over MMURD transplantation in hematologic malignancies and further quantifies the risks associated with specific HLA-allele mismatches.
Statin use has been associated with reduced cancer‐specific mortality among patients with several cancer types, including multiple myeloma (MM). We aimed to further elucidate the association of statin use and dose intensity with MM survival. Using Swedish population‐based national health registers, we identified all incident MM diagnoses occurring January 1, 2007 to December 31, 2013 and their drug dispensations and comorbidities. We assessed statin exposure in 6‐month periods pre‐ and post‐diagnosis, treated diagnosis as baseline for calculating survival time, and calculated hazard ratios (HR) and 95% confidence intervals (CI) of exposure‐related MM‐specific and all‐cause mortality using Cox regression. We assessed statin exposure during the entire follow‐up and risk of MM‐specific mortality in a nested case‐control analysis. We classified dose intensity according to American College of Cardiology/American Heart Association recommendations. We ascertained 4315 MM cases during follow‐up. Statin use was associated with reduced MM‐specific mortality (pre‐diagnosis use multivariate‐adjusted HR, 95% CI: 0.83, 0.71‐0.96; 6 months post‐diagnosis: 0.73, 0.60‐0.89; entire follow‐up: 0.65, 0.52‐0.80) and (more weakly) with all‐cause mortality. Intensity analyses suggested a dose‐response; MM‐specific mortality decreased with increasing statin intensity in all time windows (eg, 6 months post‐diagnosis: low [0.76 (0.56‐1.03)], medium [0.73 (0.58‐0.92)], high [0.33 (0.08‐1.32)] intensity). However, relatively few patients received high intensity treatment, and the trend was statistically significant only for unadjusted pre‐diagnosis use.In this large population‐based MM cohort, statin use was associated with improved MM‐specific survival in both sexes. Randomized prospective studies are warranted to evaluate statins as adjuvant treatment in MM.
Summary Statin use has been associated with reduced mortality from several cancers but also suggested, in vitro, to diminish the effectiveness of lymphoma treatments including rituximab. The present study aimed to assess the association of statin use with mortality in patients with non‐Hodgkin lymphoma (NHL) and chronic lymphocytic leukaemia (CLL). We identified all incident NHLs and CLLs in Sweden from 2007 to 2013 with subtype information in the Swedish Lymphoma and Cancer Registers. Using Cox regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of pre‐ or post‐diagnosis statin use (yes/no, intensity) with lymphoma‐specific, cardiovascular, or all‐cause mortality; and for follicular lymphoma (FL) by initial treatment strategy (active/watch‐and‐wait). Among 16 098 incident NHL/CLL patients, 20% used statins at diagnosis. Pre‐ and post‐diagnosis statin use, and statin intensity were not consistently associated with any mortality outcome in patients with NHL, overall or for any subtype. For actively treated patients with FL, statin use did not appear to increase lymphoma‐specific mortality (vs. non‐users, HR [95% CI]after diagnosis 0·87 [0·45–1·67]). For CLL, statin use was associated with all‐cause and cardiovascular but not consistently with lymphoma‐specific mortality. In conclusion, statin use was not associated with improved lymphoma survival but appears safe to use during lymphoma treatment.
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