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Hantel A, Cernik C, Uno H, Walsh TP, Calip GS, DeAngelo DJ, Lathan CS, Abel GA. Sociodemographic associations with uptake of novel therapies for acute myeloid leukemia. Blood Cancer J 2023; 13:192. [PMID: 38123559 PMCID: PMC10733304 DOI: 10.1038/s41408-023-00964-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Inequitable uptake of novel therapies (NT) in non-cancer settings are known for patients with lower socioeconomic status (SES), People of Color (POC), and older adults. NT uptake equity in acute myeloid leukemia (AML) is not well known. We performed a retrospective cohort study (1/2014-8/2022) of the United States nationwide Flatiron HealthTM electronic health record-derived, de-identified database. We estimated sociodemographic associations with AML NT receipt using incidence rate ratios (IRR). Odds ratios (OR) assessed differences in venetoclax (the most common NT) receipt at community sites and between site characteristics and NT adoption. Of 8081 patients (139 sites), 3102 (38%) received a NT. NT use increased annually (IRR 1.14, 95% confidence interval [1.07, 1.22]). NT receipt was similar between Non-Hispanic-Whites and POC (IRR 1.03, [0.91, 1.17]) and as age increased (IRR 1.02 [0.97, 1.07]). At community sites, Non-Hispanic-Whites were less likely to receive venetoclax (OR 0.77 [0.66, 0.91]); older age (OR 1.05 [1.04, 1.05]) and higher area-level SES were associated with venetoclax receipt (OR 1.23 [1.05, 1.43]). Early NT adopting sites had more prescribing physicians (OR 1.25 [1.13, 1.43]) and higher SES strata patients (OR 2.81 [1.08, 7.66]). Inequities in AML NT uptake were seen by SES; for venetoclax, differential uptake reflects its label indication for older adults and those with comorbidities.
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Affiliation(s)
- Andrew Hantel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- HMS Center for Bioethics, Boston, MA, USA
| | - Colin Cernik
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hajime Uno
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Thomas P Walsh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Gregory S Calip
- Flatiron Health, New York, NY, USA
- University of Southern California, Los Angeles, CA, USA
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher S Lathan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gregory A Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- HMS Center for Bioethics, Boston, MA, USA.
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Ayala R, Carreño-Tarragona G, Barragán E, Boluda B, Larráyoz MJ, Chillón MC, Carrillo-Cruz E, Bilbao C, Sánchez-García J, Bernal T, Martinez-Cuadron D, Gil C, Serrano J, Rodriguez-Medina C, Bergua J, Pérez-Simón JA, Calbacho M, Alonso-Domínguez JM, Labrador J, Tormo M, Amigo ML, Herrera-Puente P, Rapado I, Sargas C, Vazquez I, Calasanz MJ, Gomez-Casares T, García-Sanz R, Sanz MA, Martínez-López J, Montesinos P. Impact of FLT3-ITD Mutation Status and Its Ratio in a Cohort of 2901 Patients Undergoing Upfront Intensive Chemotherapy: A PETHEMA Registry Study. Cancers (Basel) 2022; 14:cancers14235799. [PMID: 36497281 PMCID: PMC9737662 DOI: 10.3390/cancers14235799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022] Open
Abstract
FLT3−ITD results in a poor prognosis in terms of overall survival (OS) and relapse-free survival (RFS) in acute myeloid leukemia (AML). However, the prognostic usefulness of the allelic ratio (AR) to select post-remission therapy remains controversial. Our study focuses on the prognostic impact of FLT3−ITD and its ratio in a series of 2901 adult patients treated intensively in the pre-FLT3 inhibitor era and reported in the PETHEMA registry. A total of 579 of these patients (20%) harbored FLT3−ITD mutations. In multivariate analyses, patients with an FLT3−ITD allele ratio (AR) of >0.5 showed a lower complete remission (CR rate) and OS (HR 1.47, p = 0.009), while AR > 0.8 was associated with poorer RFS (HR 2.1; p < 0.001). Among NPM1/FLT3−ITD-mutated patients, median OS gradually decreased according to FLT3−ITD status and ratio (34.3 months FLT3−ITD-negative, 25.3 months up to 0.25, 14.5 months up to 0.5, and 10 months ≥ 0.5, p < 0.001). Post-remission allogeneic transplant (allo-HSCT) resulted in better OS and RFS as compared to auto-HSCT in NPM1/FLT3−ITD-mutated AML regardless of pre-established AR cutoff (≤0.5 vs. >0.5). Using the maximally selected log-rank statistics, we established an optimal cutoff of FLT3−ITD AR of 0.44 for OS, and 0.8 for RFS. We analyzed the OS and RFS according to FLT3−ITD status in all patients, and we found that the group of FLT3−ITD-positive patients with AR < 0.44 had similar 5-year OS after allo-HSCT or auto-HSCT (52% and 41%, respectively, p = 0.86), but worse RFS after auto-HSCT (p = 0.01). Among patients with FLT3−ITD AR > 0.44, allo-HSCT was superior to auto-HSCT in terms of OS and RFS. This study provides more evidence for a better characterization of patients with AML harboring FLT3−ITD mutations.
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Affiliation(s)
- Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Gonzalo Carreño-Tarragona
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Eva Barragán
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, 46026 Valencia, Spain
| | - Blanca Boluda
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | | | - María Carmen Chillón
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Estrella Carrillo-Cruz
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41120 Sevilla, Spain
| | - Cristina Bilbao
- Hospital Universitario de Gran Canaria Dr. Negrín, 35002 Las Palmas de Gran Canaria, Spain
| | | | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - David Martinez-Cuadron
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Josefina Serrano
- IMIBIC, Hematology, Hospital Universitario Reina Sofía, UCO, 14004 Córdoba, Spain
| | | | - Juan Bergua
- Hospital Universitario San Pedro de Alcántara, 10001 Cáceres, Spain
| | - José A. Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41120 Sevilla, Spain
| | - María Calbacho
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | | | - Jorge Labrador
- Research Unit, Hematology Department, Hospital Universitario de Burgos, Universidad Isabel I, 09006 Burgos, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario-INCLIVA, 46026 Valencia, Spain
| | - Maria Luz Amigo
- Hospital Universitario Morales Messeguer, 30008 Murcia, Spain
| | | | - Inmaculada Rapado
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
| | - Claudia Sargas
- Molecular Biology Unit, Hospital Universitari i Politécnic-IIS La Fe, 46026 Valencia, Spain
| | - Iria Vazquez
- CIMA LAB Diagnostics, Universidad de Navarra, 31008 Pamplona, Spain
| | | | - Teresa Gomez-Casares
- Hospital Universitario de Gran Canaria Dr. Negrín, 35002 Las Palmas de Gran Canaria, Spain
| | - Ramón García-Sanz
- Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Miguel A. Sanz
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
| | - Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, i+12, CNIO, CIBERONC, Complutense University, 28041 Madrid, Spain
- Correspondence: (J.M.-L.); (P.M.); Tel.: +34-917-792-788 (J.M.-L.); +34-961-244-925 (P.M.); Fax: +34-961-246-201 (P.M.)
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politécnic-IIS La Fe, CIBERONC, 46026 Valencia, Spain
- Correspondence: (J.M.-L.); (P.M.); Tel.: +34-917-792-788 (J.M.-L.); +34-961-244-925 (P.M.); Fax: +34-961-246-201 (P.M.)
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Casey M, Odhiambo L, Aggarwal N, Shoukier M, Garner J, Islam KM, Cortes JE. Are Pivotal Clinical Trials for Drugs Approved for Leukemias and Multiple Myeloma Representative of the Population at Risk? J Clin Oncol 2022; 40:3719-3729. [PMID: 35944216 DOI: 10.1200/jco.22.00504] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There are significant disparities in care and outcomes for patients with leukemias and multiple myeloma (MM). To evaluate the extent to which clinical trials (CTs) match the demographic and geographic diversity of populations affected by leukemias and MM. METHODS CTs leading to drug approval were identified from the US Food and Drug Administration databases. Demographic and geographic data were collected from ClinicalTrials.gov and primary manuscripts. Standard descriptive statistics were used to summarize the data in frequencies and proportions, including 95% CIs, by race, ethnicity, sex, and malignancy subtypes. RESULTS A total of 41 (67.2%) trials leading to drug approval reported data on race and 20 (48.8%) on ethnicity. These trials included 13,731 patients, of whom 11,209 (81.6%) were White. Among minorities, Asian-Pacific Islanders and Blacks had the highest representation in chronic myeloid leukemia, 147 (12.7%) and 61 (5.3%), and lowest in chronic lymphocytic leukemia, 55 (3%) and 20 (1.1%), respectively. Proportions for Blacks, Native Americans, and Hispanics were significantly low, reflecting under-representation in trials compared with the proportion in the general population. Females were also under-represented in acute myeloid leukemia (44.7% v 60.5%, P < .0001), and males in MM (55.3% v 60.2%, P < .0001) and chronic myeloid leukemia (55.2% v 62.9%, P < .0001). The geographic distribution of trials showed inadequate regional and state participation compared with mortality for all malignancies except MM. CONCLUSION There are significant demographic and geographic under-representation and imbalances in pivotal CTs leading to drug approvals for leukemias and MM compared with the population affected. These disparities need to be addressed to make results applicable to all relevant populations.
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Affiliation(s)
- Mycal Casey
- Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA
| | - Lorriane Odhiambo
- Institute of Public Health and Preventive Health, Augusta University, Augusta, GA
| | - Nidhi Aggarwal
- Medical College of Georgia at Augusta University, Augusta, GA
| | | | - Jamani Garner
- Institute of Public Health and Preventive Health, Augusta University, Augusta, GA
| | - K M Islam
- Institute of Public Health and Preventive Health, Augusta University, Augusta, GA.,Medical College of Georgia at Augusta University, Augusta, GA
| | - Jorge E Cortes
- Georgia Cancer Center at Augusta University, Augusta, GA
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4
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Schneider IJC, Schmidt TP, Correa VP, dos Santos AMM, da Rocha BV, Garcia LP, Ceccon RF. Tobacco-related neoplasms: survival analysis and risk of death of population data from Florianópolis, SC. Rev Saude Publica 2022; 56:16. [PMID: 35416842 PMCID: PMC8973025 DOI: 10.11606/s1518-8787.2022056003651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the probability of survival and prognostic factors for tobacco-related neoplasms in a population-based cohort. METHODS This is a cohort with data from the Population-Based Cancer Registry of Florianópolis, southern Brazil, from 2008 to 2012. The Stata 16.0 software was used to estimate the probabilities of survival in five years after diagnosis, by the Kaplan Meier method, and the risk of death, by the Cox regression. RESULTS A total of 2,829 cancer records related to smoking were included, more prevalent among males, over 70 years of age, nine years or more of schooling, white, with a partner and metastatic diagnosis. The most frequent groupings were colon and rectum (28.7%), trachea, bronchi and lungs (18.6%) and stomach (11.8%). At follow-up, 1,450 died. Pancreatic cancer had the worst probability of survival (14.3%), followed by liver cancer (19.4%). CONCLUSION Risk factors for death and survival rates differ across the 13 types of tobacco-related cancers. Early diagnosis and primary prevention are strategies that must be improved to improve survival and decrease the burden related to these types of cancer.
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Affiliation(s)
- Ione Jayce Ceola Schneider
- Universidade Federal de Santa CatarinaDepartamento de Ciências da SaúdeAraranguáSCBrasilUniversidade Federal de Santa Catarina. Departamento de Ciências da Saúde. Araranguá, SC, Brasil
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Ciências da ReabilitaçãoAraranguáSCBrasilUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Ciências da Reabilitação. Araranguá, SC, Brasil
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Saúde ColetivaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Saúde Coletiva. Florianópolis, SC, Brasil
| | - Tauana Prestes Schmidt
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Ciências da ReabilitaçãoAraranguáSCBrasilUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Ciências da Reabilitação. Araranguá, SC, Brasil
| | - Vanessa Pereira Correa
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Ciências da ReabilitaçãoAraranguáSCBrasilUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Ciências da Reabilitação. Araranguá, SC, Brasil
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Saúde ColetivaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Saúde Coletiva. Florianópolis, SC, Brasil
| | - Ana Maria Martins dos Santos
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Ciências da ReabilitaçãoAraranguáSCBrasilUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Ciências da Reabilitação. Araranguá, SC, Brasil
| | - Bruna Vanti da Rocha
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Ciências da ReabilitaçãoAraranguáSCBrasilUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Ciências da Reabilitação. Araranguá, SC, Brasil
- Universidade Federal de Santa CatarinaPrograma de Pós-Graduação em Saúde ColetivaFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Saúde Coletiva. Florianópolis, SC, Brasil
| | - Leandro Pereira Garcia
- Secretaria Municipal de Saúde de FlorianópolisFlorianópolisSCBrasilSecretaria Municipal de Saúde de Florianópolis. Florianópolis, SC, Brasil
| | - Roger Flores Ceccon
- Universidade Federal de Santa CatarinaDepartamento de Ciências da SaúdeAraranguáSCBrasilUniversidade Federal de Santa Catarina. Departamento de Ciências da Saúde. Araranguá, SC, Brasil
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Holtzman NG, Lebowitz MS, Koka R, Baer MR, Malhotra K, Shahlaee A, Ghanbari HA, Bentzen SM, Emadi A. Aspartate β-Hydroxylase (ASPH) Expression in Acute Myeloid Leukemia: A Potential Novel Therapeutic Target. Front Oncol 2022; 11:783744. [PMID: 35004304 PMCID: PMC8727599 DOI: 10.3389/fonc.2021.783744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Aspartate β-hydroxylase (ASPH) is an embryonic transmembrane protein aberrantly upregulated in cancer cells, associated with malignant transformation and, in some reports, with poor clinical prognosis. Objective To report the expression patterns of ASPH in acute myeloid leukemia (AML). Methods Cell surface expression of ASPH was measured via 8-color multiparameter flow cytometry in 41 AML patient samples (31 bone marrow, 10 blood) using fluorescein isothiocyanate (FITC)-conjugated anti-ASPH antibody, SNS-622. A mean fluorescent intensity (MFI) of 10 was used as a cutoff for ASPH surface expression positivity. Data regarding patient and disease characteristics were collected. Results ASPH surface expression was found on AML blasts in 16 samples (39%). Higher ASPH expression was seen in myeloblasts of African American patients (p=0.02), but no correlation was found between ASPH expression and other patient or disease characteristics. No association was found between ASPH status and CR rate (p=0.53), EFS (p=0.87), or OS (p=0.17). Conclusions ASPH is expressed on blasts in approximately 40% of AML cases, and may serve as a new therapeutically targetable leukemia-associated antigen.
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Affiliation(s)
- Noa G Holtzman
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States.,Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | | | - Rima Koka
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Maria R Baer
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kanam Malhotra
- Sensei Biotherapeutics Inc., Gaithersburg, MD, United States
| | - Amir Shahlaee
- Sensei Biotherapeutics Inc., Gaithersburg, MD, United States
| | | | - Søren M Bentzen
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Epidemiology and Biostatistics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ashkan Emadi
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
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6
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Racial and ethnic survival disparities in patients with haematological malignancies in the USA: time to stop ignoring the numbers. THE LANCET HAEMATOLOGY 2021; 8:e947-e954. [DOI: 10.1016/s2352-3026(21)00303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 12/17/2022]
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7
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Racial and ethnic enrollment disparities and demographic reporting requirements in acute leukemia clinical trials. Blood Adv 2021; 5:4352-4360. [PMID: 34473244 PMCID: PMC8579250 DOI: 10.1182/bloodadvances.2021005148] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/24/2021] [Indexed: 12/21/2022] Open
Abstract
Public demographic reporting for acute leukemia trials is inadequate, and NH-White subjects are more likely to be enrolled. Larger racial-ethnic enrollment disparities were documented after federal reporting requirements, which may be from more data transparency.
Data regarding racial and ethnic enrollment diversity for acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL) clinical trials in the United States are limited, and little is known about the effect of federal reporting requirements instituted in the late 2000s. We examined demographic data reporting and enrollment diversity for ALL and AML trials in the United States from 2002 to 2017, as well as changes in reporting and diversity after reporting requirements were instituted. Of 223 AML trials and 97 ALL trials with results on ClinicalTrials.gov, 68 (30.5%) and 51 (52.6%) reported enrollment by both race and ethnicity. Among trials that reported race and ethnicity (AML, n = 6554; ALL, n = 4149), non-Hispanic (NH)-Black, NH-Native American, NH-Asian, and Hispanic patients had significantly lower enrollment compared with NH-White patients after adjusting for race-ethnic disease incidence (AML odds ratio, 0.68, 0.31, 0.75, and 0.83, respectively; ALL odds ratio, 0.74, 0.27, 0.67, and 0.64; all, P ≤ .01). The proportion of trials reporting race increased significantly after implementation of the reporting requirements (44.2% to 60.2%; P = .02), but race-ethnicity reporting did not (34.8% to 38.6%; P = .57). Reporting proportions according to number of patients enrolled increased significantly after the reporting requirements were instituted (race, 51.7% to 72.7%; race-ethnicity, 39.5% to 45.4%; both, P < .001), and relative enrollment of NH-Black and Hispanic patients decreased (AML odds ratio, 0.79 and 0.77; ALL odds ratio, 0.35 and 0.25; both P ≤ .01). These data suggest that demographic enrollment reporting for acute leukemia trials is suboptimal, changes in diversity after the reporting requirements may be due to additional enrollment disparities that were previously unreported, and enrollment diversification strategies specific to acute leukemia care delivery are needed.
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Why Do Children with Acute Lymphoblastic Leukemia Fare Better Than Adults? Cancers (Basel) 2021; 13:cancers13153886. [PMID: 34359787 PMCID: PMC8345615 DOI: 10.3390/cancers13153886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
It is a new and exciting time for acute lymphoblastic leukemia (ALL). While nearly 50 years ago, only one in nine children with ALL survived with chemotherapy, nowadays nearly 90% of children have a chance of long-term survival. Adults with ALL, as well as the special category of adolescents and young adult (AYA) patients, are catching up with the new developments seen in children, but still their prognosis is much worse. A plethora of factors are regarded as responsible for the differences in treatment response, such as age, ethnicity, disease biology, treatment regimens and toxicities, drug tolerance and resistance, minimal residual disease evaluation, hematopoietic stem cell transplantation timing and socio-economic factors. Taking these factors into account, bringing pediatric-like protocols to adult patient management and incorporating new agents into frontline treatment could be the key to improve the survival rates in adults and AYA.
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9
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Mounier M, Romain G, Callanan M, Alla AD, Boussari O, Maynadié M, Colonna M, Jooste V. Flexible Modeling of Net Survival and Cure by AML Subtype and Age: A French Population-Based Study from FRANCIM. J Clin Med 2021; 10:jcm10081657. [PMID: 33924506 PMCID: PMC8069423 DOI: 10.3390/jcm10081657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
With improvements in acute myeloid leukemia (AML) diagnosis and treatment, more patients are surviving for longer periods. A French population of 9453 AML patients aged ≥15 years diagnosed from 1995 to 2015 was studied to quantify the proportion cured (P), time to cure (TTC) and median survival of patients who are not cured (MedS). Net survival (NS) was estimated using a flexible model adjusted for age and sex in sixteen AML subtypes. When cure assumption was acceptable, the flexible cure model was used to estimate P, TTC and MedS for the uncured patients. The 5-year NS varied from 68% to 9% in men and from 77% to 11% in women in acute promyelocytic leukemia (AML-APL) and in therapy-related AML (t-AML), respectively. Major age-differenced survival was observed for patients with a diagnosis of AML with recurrent cytogenetic abnormalities. A poorer survival in younger patients was found in t-AML and AML with minimal differentiation. An atypical survival profile was found for acute myelomonocytic leukemia and AML without maturation in both sexes and for AML not otherwise specified (only for men) according to age, with a better prognosis for middle-aged compared to younger patients. Sex disparity regarding survival was observed in younger patients with t-AML diagnosed at 25 years of age (+28% at 5 years in men compared to women) and in AML with minimal differentiation (+23% at 5 years in women compared to men). All AML subtypes included an age group for which the assumption of cure was acceptable, although P varied from 90% in younger women with AML-APL to 3% in older men with acute monoblastic and monocytic leukemia. Increased P was associated with shorter TTC. A sizeable proportion of AML patients do not achieve cure, and MedS for these did not exceed 23 months. We identify AML subsets where cure assumption is negative, thus pointing to priority areas for future research efforts.
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Affiliation(s)
- Morgane Mounier
- Dijon-Bourgogne University Hospital, Registre des Hémopathies Malignes de Côte d’Or, F-21000 Dijon, France; (M.C.); (A.D.A.); (M.M.)
- UMR 1231, SAPHIHR Team, INSERM, Université Bourgogne-Franche_Comté, F-21000 Dijon, France
- LabEX LipSTIC, ANR-11-LABX-0021, F-21000 Dijon, France;
- Correspondence:
| | - Gaëlle Romain
- Dijon-Bourgogne University Hospital, Registre Bourguignon des Cancers Digestifs, F-21000 Dijon, France; (G.R.); (V.J.)
- UMR 1231, EPICAD Team, INSERM, Université Bourgogne-Franche_Comté, F-21000 Dijon, France
| | - Mary Callanan
- Dijon-Bourgogne University Hospital, Registre des Hémopathies Malignes de Côte d’Or, F-21000 Dijon, France; (M.C.); (A.D.A.); (M.M.)
- UMR 1231, SAPHIHR Team, INSERM, Université Bourgogne-Franche_Comté, F-21000 Dijon, France
- LabEX LipSTIC, ANR-11-LABX-0021, F-21000 Dijon, France;
| | - Akoua Denise Alla
- Dijon-Bourgogne University Hospital, Registre des Hémopathies Malignes de Côte d’Or, F-21000 Dijon, France; (M.C.); (A.D.A.); (M.M.)
- UMR 1231, SAPHIHR Team, INSERM, Université Bourgogne-Franche_Comté, F-21000 Dijon, France
- LabEX LipSTIC, ANR-11-LABX-0021, F-21000 Dijon, France;
| | - Olayidé Boussari
- LabEX LipSTIC, ANR-11-LABX-0021, F-21000 Dijon, France;
- UMR 1231, EPICAD Team, INSERM, Université Bourgogne-Franche_Comté, F-21000 Dijon, France
- Fédération Francophone de Cancérologie Digestive, Département de Méthodologie, F-21000 Dijon, France
| | - Marc Maynadié
- Dijon-Bourgogne University Hospital, Registre des Hémopathies Malignes de Côte d’Or, F-21000 Dijon, France; (M.C.); (A.D.A.); (M.M.)
- UMR 1231, SAPHIHR Team, INSERM, Université Bourgogne-Franche_Comté, F-21000 Dijon, France
- LabEX LipSTIC, ANR-11-LABX-0021, F-21000 Dijon, France;
| | - Marc Colonna
- Grenoble University Hospital, Registre du Cancer de l’Isère, F-38000 Grenoble, France;
| | - Valérie Jooste
- Dijon-Bourgogne University Hospital, Registre Bourguignon des Cancers Digestifs, F-21000 Dijon, France; (G.R.); (V.J.)
- UMR 1231, EPICAD Team, INSERM, Université Bourgogne-Franche_Comté, F-21000 Dijon, France
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10
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Yu L, Wang H, Gale RP, Qin Y, Lai Y, Shi H, Dou X, Huang X, Jiang Q. Impact of socio-demographic co-variates on prognosis, tyrosine kinase-inhibitor use and outcomes in persons with newly-diagnosed chronic myeloid leukaemia. J Cancer Res Clin Oncol 2021; 148:449-459. [PMID: 33835260 DOI: 10.1007/s00432-021-03624-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Define the impact of socio-demographic co-variates on outcomes of persons with newly-diagnosed chronic phase chronic myeloid leukaemia (CML). METHODS Data of 961 consecutive subjects with newly-diagnosed CML were integrated for these outcomes in multi-variable Cox regression analyses after adjusting for confounders and interactions. RESULTS Elder age was associated with less use of a 2nd generation TKI as initial therapy. Household registration, comorbidity(ies) and education level were associated with use of a generic rather than branded TKI as initial therapy. Subjects with lower education level were more likely to be diagnosed with CML because of leukaemia-related symptoms. Rural registration and lower education level were also associated with a greater likelihood of switching TKI-therapy. Lower education level was associated with lower likelihood of achieving MMR [HR = 0.8 (0.7, 0.9), p = 0.002], MR4.5 [HR = 0.8 (0.7, 1.0), p = 0.055], and poor FFS [HR = 1.7 (1.3, 2.5); p < 0.001], PFS [HR = 2.0 (1.1, 5.0); p = 0.014], CML-related survival [HR = 2.5 (1.0, 10.0); p = 0.060] and survival [HR = 2.5 (1.0, 10.0); p = 0.043]. Males had lower rates of MMR and MR4.5 and worse FFS, but not survival compared with females. Being married was associated with a higher rate of MR4.5, fewer failures, progressions, and deaths. CONCLUSION Socio-demographic co-variates have a strong impact on therapy choice and responses in persons with newly-diagnosed CML, including circumstances of diagnosis, risk category and prognosis, use of initial TKI, switching TKIs, response to TKI-therapy, and outcomes.
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MESH Headings
- Adolescent
- Adult
- Aged
- Demography
- Disease Progression
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Prognosis
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Socioeconomic Factors
- Surveys and Questionnaires
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Lu Yu
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Huifang Wang
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Robert Peter Gale
- Centre for Haematology Research, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Yazhen Qin
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Yueyun Lai
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Hongxia Shi
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Xuelin Dou
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Xiaojun Huang
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Qian Jiang
- National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Beijing, 100044, China.
- Collaboratives Innovation Center of Hematology, Soochow University, Suzhou, China.
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11
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Abraham IE, Patel AA, Wang H, Galvin JP, Frankfurt O, Liu L, Khan I. Impact of race on outcomes in intermediate-risk acute myeloid leukemia. Cancer Causes Control 2021; 32:705-712. [PMID: 33837498 DOI: 10.1007/s10552-021-01422-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Racial disparities in acute myeloid leukemia (AML) have been reported but the relative contribution of disease versus patient-specific factors including comorbidities and access to care is unclear. METHODS We conducted a retrospective analysis of patient characteristics, treatment patterns and outcomes in a racially diverse patient cohort controlling for cytogenetic risk group. Patients were classified into four groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic and Other. RESULTS We evaluated 106 patients from 84 zipcodes incorporating demographics, clinicopathologic features, treatment patterns and outcomes. We identified significant differences in BMI and geographic poverty based on ethnoracial group, while prognostic mutations in NPM1 and FLT3 did not differ significantly. Utilization of intensive chemotherapy and transplant rate did not differ by ethnoracial group. However, there was a significantly higher use of alternate donor transplants in minority populations. There was a notably increased rate of clinical trial enrollment in NHW patients compared to other groups. In log-rank analysis, NHW patients had increased overall survival (OS) compared to NHB, Hispanic and Other patients (31.6 months vs. 16.7 months vs. 14.3 months, vs 18.1 months, p = 0.021). In bivariate analysis, overall survival was negatively influenced by advanced age and race. Obesity and zip code poverty levels approached statistical significance in predicting OS. In multivariate analysis, the only factors independently influencing OS were race and allogeneic stem cell transplant. CONCLUSION These results suggest that race impacts survival in intermediate-risk AML, highlighting the need to dissect biologic and nonbiologic factors that contribute to this disparity.
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Affiliation(s)
- Ivy Elizabeth Abraham
- Division of Hematology and Oncology, Department of Internal Medicine, University of Illinois at Chicago, 840 South Wood Street, Ste 820 E-CSB, Chicago, IL, 60612, USA
| | - Anand Ashwin Patel
- University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Heidy Wang
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - John Patrick Galvin
- Division of Hematology and Oncology, Department of Internal Medicine, University of Illinois at Chicago, 840 South Wood Street, Ste 820 E-CSB, Chicago, IL, 60612, USA
| | - Olga Frankfurt
- Hematology and Oncology Division, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Li Liu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Irum Khan
- Division of Hematology and Oncology, Department of Internal Medicine, University of Illinois at Chicago, 840 South Wood Street, Ste 820 E-CSB, Chicago, IL, 60612, USA.
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12
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Bencomo-Alvarez AE, Rubio AJ, Gonzalez MA, Eiring AM. Blood cancer health disparities in the United States Hispanic population. Cold Spring Harb Mol Case Stud 2021; 7:a005967. [PMID: 33593728 PMCID: PMC8040735 DOI: 10.1101/mcs.a005967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cancer is a challenging, multifaceted disease that involves a combination of biological and nonbiological factors. Aside from COVID-19, cancer is the second leading cause of death in the United States and the first among Hispanic Americans. The Hispanic population is the largest minority group in the United States, which is rapidly growing in size. Unfortunately, U.S. Hispanics and other minority groups experience many different health disparities, resulting in poor survival outcomes and a reduced quality of life. Factors such as genomic mutations, lower socioeconomic status, lack of education, reduced access to health care, comorbidities, and environmental factors all contribute to these health-care inequalities. In the context of blood cancer health disparities, Hispanic patients are often diagnosed at a younger age and have worse outcomes compared with non-Hispanic individuals. In this commentary, we highlight the existing knowledge about cancer health disparities in the Hispanic population, with a focus on chronic and acute leukemia. In our experience at the U.S./Mexican border, analysis of several different blood cancers demonstrated that younger Hispanic patients with acute lymphoid or myeloid leukemia have higher incidence rates and worse prognoses. A combined approach, involving improved health-care access and better knowledge of the underlying factors, will allow for more timely diagnoses and the development of intervention strategies aimed at reducing or eliminating the disparities.
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Affiliation(s)
- Alfonso E Bencomo-Alvarez
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Andres J Rubio
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Mayra A Gonzalez
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Anna M Eiring
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
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13
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Smith-Graziani D, Flowers CR. Understanding and Addressing Disparities in Patients With Hematologic Malignancies: Approaches for Clinicians. Am Soc Clin Oncol Educ Book 2021; 41:1-7. [PMID: 33793311 DOI: 10.1200/edbk_320079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Approximately 185,840 individuals will be diagnosed with hematologic malignancies in the United States in 2020. Disparities in disease incidence, prevalence, burden, mortality, and survivorship have been identified among this patient population. Contributing factors include genetic ancestry, race/ethnicity, sex, socioeconomic status, and geographic region. Historically, these inequities have been understudied. Addressing these disparities requires a systems-level approach, improving access to care and reducing biases in the clinical setting. Additional research is needed to construct comprehensive, multilevel models to explore systematic observational studies and perform strategic intervention trials to overcome these disparities.
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Affiliation(s)
| | - Christopher R Flowers
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer, Houston, TX
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14
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Yang X, Chen H, Man J, Zhang T, Yin X, He Q, Lu M. Secular trends in the incidence and survival of all leukemia types in the United States from 1975 to 2017. J Cancer 2021; 12:2326-2335. [PMID: 33758609 PMCID: PMC7974881 DOI: 10.7150/jca.52186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Various studies have indicated that the prognosis of leukemia has been improved in recent years, but the secular trends of incidence and long-term survival of all leukemia have not been thoroughly examined. Methods: We estimated the leukemia incidence and 5-year survival rate along with the temporal trends by sex, race, age, and subtype in the United States over the past four decades using Surveillance, Epidemiology, and End Results (SEER) database. Results: The overall incidence of leukemia steadily increased from 12.39/100 000 in 1975 to 14.65/100 000 in 2011, and then began to decline in recent years (13.73/100 000 in 2017), with average annual percent changes (APC) of 0.350 (P<0.001). The 5-year relative survival rate of leukemia patients significantly improved from 33.2% in 1975 to 66.1% in 2012 (APC=1.980, P<0.001). The main subtypes of leukemia, including acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, and chronic myeloid leukemia, increased in most age groups; conversely, the incidences of all other subtypes were gradually declined during the monitoring period. The incremental advancement in leukemia prognosis had been achieved in almost all histological subtypes, especially among young patients. Conclusions: Based on SEER data, the leukemia incidence increased gradually over the past decades, and then began to decline in recent years in the United States. The 5-year relative survival rate increased incrementally over time, especially among young patients. However, the huge disparities among different sexes, races, histological subtypes, and age groups, emphasize that precise causes control and innovative treatments need to be developed to reduce the incidence and improve the prognosis, especially among specific populations.
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Affiliation(s)
- Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jinyu Man
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongchao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaolin Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiufeng He
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ming Lu
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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15
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Impact of age and treatment institution type on outcomes of patients treated for chronic lymphocytic leukemia in British Columbia, Canada. Leuk Res 2021; 103:106538. [PMID: 33647819 DOI: 10.1016/j.leukres.2021.106538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/21/2021] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
Abstract
Older age has been shown to adversely impact overall survival (OS) in chronic lymphocytic leukemia (CLL) however, prior population-based studies did not analyze the impact of cytogenetic abnormalities or were prior to the availability of ibrutinib. OBJECTIVES i) We sought to compare outcomes of patients based on their age at treatment to examine if older age has an impact on OS in patients who were treated during the period when fludarabine-rituximab was the standard upfront therapy and when ibrutinib was first introduced and ii) compare outcomes based on whether the patient received primary treatment at an academic or community-based centre. METHODS The BC Provincial CLL Database, a population-based databasewas used to include patients who have received treatment in British Columbia (BC), Canada between 2004 and 2016. RESULTS A total of 1122 patients were included (<70 years at treatment, n = 589) with median age at diagnosis 66 years. Younger patients had higher Rai stage (55% vs. 44% stage I-II, p < 0.001), higher lymphocyte count at diagnosis (13 × 109/L vs. 10 × 109/L, p = 0.004), greater proportion with B-symptoms at diagnosis (15% vs 10%, p = 0.004), shorter time from diagnosis to treatment (13.9 months vs. 21.4 months, p = 0.001), higher proportion treated at an academic centre (79% vs. 69%, p < 0.001) and more were treated with fludarabine-rituximab or FCR (69% vs. 42%, p < 0.001) compared to older patients. Older patients had both a significantly (p < 0.001) shorter OS from treatment start (4.7 years) and disease specific survival (8.1 years) than younger patients (median OS and DSS not reached). Of interest, there was no difference in OS between patients treated at an academic centre or community centre (p = 0.087). First-line treatment with chemoimmunotherapy improved OS (HR 0.465, 95% CI: 0.381-.567). CONCLUSIONS Older age but not treatment-institution type adversely impacts overall survival and CLL survival in treated patients in BC.
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16
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Hyer JM, Tsilimigras DI, Diaz A, Mirdad RS, Azap RA, Cloyd J, Dillhoff M, Ejaz A, Tsung A, Pawlik TM. High Social Vulnerability and "Textbook Outcomes" after Cancer Operation. J Am Coll Surg 2021; 232:351-359. [PMID: 33508426 DOI: 10.1016/j.jamcollsurg.2020.11.024] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effect of community-level factors on surgical outcomes has not been well examined. We sought to characterize differences in "textbook outcomes" (TO) relative to social vulnerability among Medicare beneficiaries who underwent operations for cancer. METHODS Individuals who underwent operations for lung, esophageal, colon, or rectal cancer between 2013 and 2017 were identified using the Medicare database, which was merged with the CDC's Social Vulnerability Index (SVI). TO was defined as surgical episodes with the absence of complications, extended length of stay, readmission, and mortality. The association of SVI and TO was assessed using mixed-effects logistic regression. RESULTS Among 203,800 patients (colon, n = 113,929; lung, n = 70,642; rectal, n = 14,849; and esophageal, n = 4,380), median age was 75 years (interquartile range 70 to 80 years) and the overwhelming majority of patients was White (n = 184,989 [90.8%]). The overall incidence of TO was 56.1% (n = 114,393). The incidence of complications (low SVI: 21.5% vs high SVI: 24.0%) and 90-day mortality (low SVI: 7.0% vs high SVI: 8.4%) were higher among patients from highly vulnerable neighborhoods (both, p < 0.05). In turn, there were lower odds of achieving TO among high-vs low-SVI patients (odds ratio 0.83; 95% CI, 0.78 to 0.87). Although high-SVI White patients had 10% lower odds (95% CI, 0.87 to 0.93) of achieving TO, high-SVI non-White patients were at 22% lower odds (95% CI, 0.71 to 0.85) of postoperative TO. Compared with low-SVI White patients, high-SVI minority patients had 47% increased odds of an extended length of stay, 40% increased odds of a complication, and 23% increased odds of 90-day mortality (all, p < 0.05). CONCLUSIONS Only roughly one-half of Medicare beneficiaries achieved the composite optimal TO quality metric. Social vulnerability was associated with lower attainment of TO and an increased risk of adverse postoperative surgical outcomes after several common oncologic procedures. The effect of high SVI was most pronounced among minority patients.
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Affiliation(s)
- J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Adrian Diaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | | | - Rosevine A Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Allan Tsung
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
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17
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Bencomo-Alvarez AE, Gonzalez MA, Rubio AJ, Olivas IM, Lara JJ, Padilla O, Orazi A, Corral J, Philipovskiy A, Gaur S, Mulla ZD, Dwivedi AK, Eiring AM. Ethnic and border differences on blood cancer presentation and outcomes: A Texas population-based study. Cancer 2020; 127:1068-1079. [PMID: 33616915 DOI: 10.1002/cncr.33347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Texas/Chihuahua (US/Mexico) border is a medically underserved region with many reported barriers for health care access. Although Hispanic ethnicity is associated with health disparities for many different diseases, the population-based estimates of incidence and survival for patients with blood cancer along the border are unknown. The authors hypothesized that Hispanic ethnicity and border proximity is associated with poor blood cancer outcomes. METHODS Data from the Texas Cancer Registry (1995-2016) were used to investigate the primary exposures of patient ethnicity (Hispanic vs non-Hispanic) and geographic location (border vs non-border). Other confounders and covariates included sex, age, year of diagnosis, rurality, insurance status, poverty indicators, and comorbidities. The Mantel-Haenszel method and Cox regression analyses were used to determine adjusted effects of ethnicity and border proximity on the relative risk (RR) and survival of patients with different blood cancer types. RESULTS Hispanic patients were diagnosed at a younger age than non-Hispanic patients and presented with increased comorbidities. Whereas non-Hispanics had a higher incidence of developing blood cancer compared with Hispanics overall, Hispanics demonstrated a higher incidence of acute lymphoblastic leukemia (RR, 1.92; 95% CI, 1.79-2.08; P < .001) with worse outcomes. Hispanics from the Texas/Chihuahua border demonstrated a higher incidence of chronic myeloid leukemia (RR, 1.28; 95% CI, 1.07-1.51; P = .02) and acute myeloid leukemia (RR, 1.17; 95% CI, 1.04-1.33; P = .0009) compared with Hispanics living elsewhere in Texas. CONCLUSIONS Hispanic ethnicity and border proximity were associated with a poor presentation and an adverse prognosis despite the younger age of diagnosis. Future studies should explore differences in disease biology and treatment strategies that could drive these regional disparities.
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Affiliation(s)
- Alfonso E Bencomo-Alvarez
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Mayra A Gonzalez
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Andres J Rubio
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Idaly M Olivas
- Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Joshua J Lara
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Osvaldo Padilla
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Attilio Orazi
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Javier Corral
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Alexander Philipovskiy
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Sumit Gaur
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Zuber D Mulla
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.,Office of Faculty Development, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Anna M Eiring
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.,Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
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18
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DEMİR D, VURAL F, ÖZSAN N, DEMİR E, KEKLİK F, PAŞAYEV T, AKAD SOYER N, HEKİMGİL M, SAYDAM G. Ege Üniversitesi hastanesi veri tabanında kayıtlı erişkin akut lösemi olgularının epidemiyolojik ve genel sağkalım özelliklerinin retrospektif olarak değerlendirilmesi. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.815327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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