Population-specific prognostic models are needed to stratify outcomes for African-Americans with diffuse large B-cell lymphoma

Chen, Qiushi; Ayer, Turgay; Nastoupil, Loretta J.; Koff, Jean L.; Staton, Ashley D.; Chhatwal, Jagpreet; Flowers, Christopher R.

doi:10.3109/10428194.2015.1083098

Cited by 8 publications

(9 citation statements)

References 55 publications

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Section: Introductionmentioning

confidence: 99%

“…Identifying predictors of poor outcomes has been a central focus of recent research in DLBCL, in which a variety of biological, clinical, and sociodemographic factors have been identified as contributors to the disparity in DLBCL outcomes. 6,[10][11][12][13] Most recently, using a large data set, Howlader et al conducted a population-based study of patients aged ≥20 years to investigate predictors of DLBCL-associated death, and to assess cure outcomes with risk stratification in the R-CHOP era (ie, from 2002 onward). 11 The authors identified advanced stage of disease, older age, black race, and Hispanic ethnicity as predictors of worse DLBCL-specific survival and found that being married and of female sex were associated with a lower risk of DLBCL-specific death.…”

Section: Introductionmentioning

confidence: 99%

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A population‐based multistate model for diffuse large B‐cell lymphoma–specific mortality in older patients

Çaǧlayan

Goldstein

Ayer

et al. 2019

Cancer

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BACKGROUND: Despite effective therapies, outcomes for diffuse large B-cell lymphoma (DLCBL) remain heterogeneous in older individuals due to comorbid diseases and variations in disease biology. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors conducted a multistate survival analysis of 11,780 patients with DLBCL who were aged ≥65 years at the time of diagnosis (2002–2009). Cox proportional hazards models were used to specify the impact of prognostic factors on overall survival and cause-specific deaths, and the Aalen-Johansen estimator was used to project the course of DLBCL over time with or without standard therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). RESULTS: Advanced age (hazard ratio [HR] for ages 71–75 years: 1.25; HR for ages 76–80 years: 1.46; HR for ages 81–85 years: 1.88; and HR for age ≥86 years: 2.26), DLBCL stage (HR for Ann Arbor stage II: 1.28; HR for stage III: 1.54; and HR for stage IV: 1.95), Charlson Comorbidity Index (CCI) ≥1 (HR for CCI of 1, 1.15; and HR for CCI >1, 1.37), and not being married (HR, 1.12) were associated with an increased risk of DLBCL-specific death. Being female (HR, 0.91) and of higher socioeconomic status (HR, 0.91) were associated with a lower risk of DLBCL-related mortality after therapy. For patients treated with R-CHOP (3610 patients), the risk of death due to DLBCL was 14.0% and 18.6%, respectively, at 2 and 5 years of treatment and plateaued afterward, confirming a 5-year “cure” point while receiving R-CHOP among older patients. CONCLUSIONS: Conducting a survival analysis over a large data set, the current study evaluated competing risks for death within a multistate modeling framework, and identified age, sex, and CCI as risk factors for DLBCL-specific and other causes of death.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A population‐based multistate model for diffuse large B‐cell lymphoma–specific mortality in older patients

Çaǧlayan

Goldstein

Ayer

et al. 2019

Cancer

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“…These patients often present with a more aggressive course, higher stage, and present 10 years younger than white patients (7). Furthermore, traditionally used prognostic models, such the International Prognostic Index (IPI) in diffuse large B cell lymphoma (DLBCL) patients and FLIPI in follicular lymphoma, are not reliably applicable to black patients as compared to white patients, possibly secondary to different tumor biology, although the specifics of these differences have yet to be fully elucidated (8). …”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, providers are often hesitant to administer rituximab to pregnant patients out of concern for possible fetal harm in the event of an infusion reaction (17). Aside from the treatment itself, timing of treatment is often a challenge faced when treating pregnant women with cancer as, ideally, chemotherapy should be delayed if possible until the second trimester to allow for fetal organogenesis (8,15). In the largest retrospective study of pregnant lymphoma patients treated with non-anti-metabolite chemotherapy, Evens et al noted an overall response rate of 82% and a complete response rate of 64%, which suggested that pregnant women could be successfully treated with chemotherapy and achieve similar outcomes to non-pregnant patients.…”

Section: Methodsmentioning

confidence: 99%

Disparities in lymphoma on the basis of race, gender, HIV status, and sexual orientation

2017

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Lymphoid malignancies account for the sixth leading cause of death in the US, and, although survival is improving overall, this trend is not applicable to all patients. In this review, we describe disparities in the initial presentation, treatment, and outcomes across a diverse group of lymphoma patients on the basis of gender, race, HIV status, and sexual orientation. Identifying these disparities will hopefully lead to improved outcomes in these groups of lymphoma patients in the future.

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“…Despite these advances, patients with DLBCL have disparate outcomes based on clinical factors, biological subtypes, race, and even insurance status . Howlader et al have attempted to refine cure estimates by assessing risk‐stratified outcomes in a large data set.…”

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confidence: 99%

Prognostic modeling in diffuse large B‐cell lymphoma in the era of immunochemotherapy: Where do we go from here?

Koff

Flowers

2017

Cancer

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The model and approach described by Howlader et al could form a foundation for future risk‐prediction models that incorporate data on known differences in demographic, socioeconomic, clinical, and biological factors. Data from large diffuse large B‐cell lymphoma patient cohorts that capture host and tumor genomics and known clinical prognostic factors will be necessary to provide the resources for constructing meaningful prognostic models and to establish prediction models that will allow us to limit therapy and therapy‐related toxicity for favorable subsets of patients while optimizing directed approaches for poor‐risk subsets. See also pages 3326‐34.

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Population-specific prognostic models are needed to stratify outcomes for African-Americans with diffuse large B-cell lymphoma

Cited by 8 publications

References 55 publications

A population‐based multistate model for diffuse large B‐cell lymphoma–specific mortality in older patients

A population‐based multistate model for diffuse large B‐cell lymphoma–specific mortality in older patients

Disparities in lymphoma on the basis of race, gender, HIV status, and sexual orientation

Prognostic modeling in diffuse large B‐cell lymphoma in the era of immunochemotherapy: Where do we go from here?

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