Characterizing Lymphoma Incidence and Disparities for a Cancer Center Catchment Region

Ayers, Amy; Lin, Li; Dance, Kaylin V.; Ward, Kevin C.; Flowers, Christopher R.; Koff, Jean L.; McCullough, Lauren E.

doi:10.1016/j.clml.2019.06.009

Cited by 6 publications

(6 citation statements)

References 42 publications

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“…21 Generally, Black patients are more likely to be diagnosed with DLBCL at a younger age, have stage 3-4 disease, and have a worse 5-year survival rate relative to white patients. 22 However, in the ZUMA-1 and ZUMA-7 clinical trials, older age did not impact efficacy with axi-cel and a manageable safety profile was maintained in all patients with R/R LBCL ≥65 years of age. 23,24 Additionally, in the real-world cohort, a larger proportion of non-Hispanic Black patients had ≥12-month timeframes from diagnosis to infusion compared with all other patients, suggesting axi-cel may have been reserved as a treatment option in later lines of therapy.…”

Section: Discussionmentioning

confidence: 92%

“…Healthcare providers may consider developing active inclusion strategies to limit race-and ethnicity-based social deterrents to CAR T-cell therapy to benefit a broader range of patients. 22,26,39 A successful treatment approach may also include patient-specific screening; for example, based on the safety findings with axi-cel in this study, risk factors for thrombocytopenia could be assessed in all non-Hispanic Asian patients. 26 As with all observational studies, this analysis had some key limitations.…”

Section: Discussionmentioning

confidence: 99%

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Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity

Locke,

Siddiqi,

Jacobson

et al. 2024

Blood

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Axicabtagene ciloleucel (axi-cel) is an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy approved for treatment of relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Despite extensive data supporting the use of axi-cel in patients with LBCL, outcomes stratified by race and ethnicity groups are limited. Here, we report clinical outcomes with axi-cel in patients with R/R LBCL by race and ethnicity in both real-world and clinical trial settings. In the real-world setting, 1290 patients with R/R LBCL who received axi-cel between 2017-2020 were identified from the Center for International Blood and Marrow Transplant Research database; 106 and 169 patients were included from the ZUMA-1 and ZUMA-7 clinical trials, respectively. Adjusted odds ratio (OR) and hazard ratio (HR) for race and ethnicity groups are reported. Overall survival was consistent across race/ethnicity groups. However, non-Hispanic (NH) Black patients had lower overall response rate (OR, 0.37, [95% CI, 0.22-0.63]) and lower complete response rate (OR, 0.57, [95% CI, 0.33-0.97]) than NH-white patients. NH-Black patients also had a shorter progression-free survival versus NH-white (HR, 1.41, [95% CI, 1.04-1.90]) and NH-Asian patients (HR, 1.67, [95% CI, 1.08-2.59]). NH-Asian patients had a longer duration of response compared with NH-white (HR, 0.56, [95% CI, 0.33-0.94]) and Hispanic patients (HR, 0.54, [95% CI, 0.30-0.97]). There was no difference in cytokine release syndrome by race/ethnicity; however, higher rates of any-grade ICANS were observed in NH-white patients compared with other patients. These results provide important context when treating patients with R/R LBCL with axi-cel across different racial and ethnic groups. ZUMA-1 (NCT02348216) and ZUMA-7 (NCT03391466), both registered on ClinicalTrials.gov

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity

Locke,

Siddiqi,

Jacobson

et al. 2024

Blood

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“…The etiology for this inequality cannot be determined through SEER but may relate to previously described healthcare inequalities faced by minority patients including decreased access to healthcare leading to lower rates of cancer screening and decreased detection of in situ disease, decreased follow-up, and more advanced stage at diagnosis, along with mistrust in the medical system and systemic inequities. [30][31][32][33][34][35] Our finding of increased SM risk in NHL survivors adds to the already described inequalities faced by non-white patients and interventional studies to decrease the healthcare gap should be explored in the future.…”

Section: Discussionmentioning

confidence: 95%

Secondary malignancies in non‐Hodgkin lymphoma survivors: 40 years of follow‐up assessed by treatment modality

et al. 2022

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Background Survivors of non‐Hodgkin lymphoma (NHL) have increased secondary malignancy (SM) risk. We quantified this risk by patient and treatment factors. Methods Standardized incidence ratios (SIR, observed‐to‐expected [O/E] ratio) were assessed in 142,637 NHL patients diagnosed from 1975 to 2016 in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Comparisons were made between subgroups in terms of their SIRs relative to respective endemic populations. Results In total, 15,979 patients developed SM, more than the endemic rate (O/E 1.29; p < 0.05). Compared with white patients, relative to respective endemic populations, ethnic minorities had a higher risk of SM (white O/E 1.27, 95% CI 1.25–1.29; black O/E 1.40, 95% CI 1.31–1.48; other O/E 1.59, 95% CI 1.49–1.70). Relative to respective endemic populations, patients who received radiotherapy had similar SM rates to those who did not (O/E 1.29 each), but irradiated patients had increased breast cancer ( p < 0.05). Patients who received chemotherapy had higher SM rates than those who did not (O/E 1.33 vs. 1.24, p < 0.05) including more leukemia, Kaposi sarcoma, kidney, pancreas, rectal, head and neck, and colon cancers ( p < 0.05). Conclusions This is the largest study to examine SM risk in NHL patients with the longest follow‐up. Treatment with radiotherapy did not increase overall SM risk, while chemotherapy was associated with a higher overall risk. However, certain subsites were associated with a higher risk of SM, and they varied by treatment, age group, race and time since treatment. These findings are helpful for informing screening and long‐term follow‐up in NHL survivors.

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“…DLBCL is most prevalent in elderly patients, with a median age at diagnosis in the 7 th decade of life. The incidence of DLBCL varies by race, with racial differences in age and gender distribution (26)(27)(28). However, the incidence of DLBCL increases with age for all races (27).…”

Section: Diffuse Large B-cell Lymphomamentioning

confidence: 99%

Hepatitis B Virus and B-cell lymphoma: evidence, unmet need, clinical impact, and opportunities

Rosenberg,

Poluch,

Thomas

et al. 2023

Front. Oncol.

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Nearly a billion people worldwide are infected with the hepatitis B Virus (HBV) and about a third of them have chronic infection. HBV is an important cause of morbidity and mortality, including acute and chronic hepatitis and hepatocellular carcinoma (HCC). Screening and control of primary HBV infection through vaccination represent a major advance in global public health, but large sections of the world population, in both developed and underdeveloped countries, remain unscreened and unvaccinated. In addition to being a global cause of liver disease, an important role of HBV in lymphoma has also emerged. First, the high risk of HBV reactivation in previously infected patients receiving chemo-immunotherapy necessitates the systematic evaluation of HBV serological status in all non-Hodgkin’s lymphoma (NHL) cases and preemptive antiviral therapy for those who may have chronic or occult HBV infection. Second, HBV has been shown to infect lymphocytes, namely B-cells, and has been associated with a higher risk of developing B-cell lymphoma, most clearly in countries where HBV is endemic. While the risk of HBV reactivation with chemoimmunotherapy in NHL is well known, the role and the impact of HBV as a global lymphoma risk factor and potential oncogenic driver in B-cells are very poorly understood. Here, we review the clinical and scientific evidence supporting an association between HBV and B-cell lymphoma, with a particular focus on diffuse large B-cell lymphoma (DLBCL) and provide an overview of the estimated impact of HBV infection on the biology and clinical course of DLBCL. We also discuss ways to gain a better insight into the unmet need posed by HBV in lymphoma and whether assessing immune responses to HBV, measuring viral loads, and detecting the presence of HBV-encoded proteins in tumor tissue could be integrated into the molecular and clinical risk stratification of patients with DLBCL.

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Characterizing Lymphoma Incidence and Disparities for a Cancer Center Catchment Region

Cited by 6 publications

References 42 publications

Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity

Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity

Secondary malignancies in non‐Hodgkin lymphoma survivors: 40 years of follow‐up assessed by treatment modality

Hepatitis B Virus and B-cell lymphoma: evidence, unmet need, clinical impact, and opportunities

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