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Wang R, Tang H, Cui P, Du R, Wang P, Sun Q, Fu H, Lu H, Li X, Zhang T, Chen C. The influence of resourcefulness on the family functioning of young- and middle-aged lymphoma patients in China: a cross-sectional study. Fam Pract 2024; 41:360-368. [PMID: 38217367 DOI: 10.1093/fampra/cmad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Lymphoma has become 1 of the 10 most common cancers with increased prevalence in young- and middle-aged adults in China. This poses a tremendous burden on patients and their families and brings great challenges to maintaining the balance of family functioning in young- and middle-aged patients. OBJECTIVE This cross-sectional study aimed to analyse the influence of resourcefulness on the family functioning of Chinese young- and middle-aged lymphoma patients. METHODS A total of 172 Chinese young- and middle-aged patients with lymphoma were recruited from the oncology departments of two tertiary hospitals in Zhengzhou, Henan, China. They were invited to complete a survey that included a demographic questionnaire, the Resourcefulness Scale and the Chinese Version Family Adaptability and Cohesion Scale II. Multiple linear regression was used to analyse the related factors for family functioning. RESULTS The multiple regression analysis revealed that the main influencing factors of family cohesion were resourcefulness (β = 0.338, 95% CI (0.072, 0.173)), spouse caregiver (β = 0.376, 95% CI (1.938, 10.395)), and cancer stage (β = -0.274, 95% CI (-3.219, -1.047)). Resourcefulness (β = 0.438, 95% CI (0.096, 0.181)), spouse caregiver (β = 0.340, 95% CI (1.348, 8.363)), and family per capita monthly income (β = 0.157, 95% CI (0.066, 2.243)) were the influencing factors of family adaptability. CONCLUSIONS Healthcare professionals and family scholars should value young- and middle-aged lymphoma patients' family functioning throughout the cancer treatment process, and family interventions should be designed by healthcare providers based on patients' resourcefulness. Moreover, healthcare providers need to pay attention to the risk factors of patients' family cohesion and adaptability, such as low family per capita monthly income, and consider employing corresponding measures to help them.
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Affiliation(s)
- Ruibo Wang
- The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
- Department of Quality Control, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, China
| | - Han Tang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, Xi' an, China
- Department of Clinical Nursing, School of Nursing, The Fourth Military Medical University, Xi' an, China
| | - Panpan Cui
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruofei Du
- The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Panpan Wang
- The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Qiaozhi Sun
- Pediatric Outpatient Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hang Fu
- Hospital Office Room, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Hongmei Lu
- Medical Department, Henan Cancer Hospital, Zhengzhou, China
| | - Xuekun Li
- Interventional Operating Room, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tiange Zhang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changying Chen
- The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
- Department of Quality Control, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
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Oluwole OO, Ray MD, Zur RM, Ferrufino CP, Doble B, Patel AR, Bilir SP. Cost-effectiveness of treating relapsed or refractory 3L+ follicular lymphoma with axicabtagene ciloleucel vs mosunetuzumab in the United States. Front Immunol 2024; 15:1393939. [PMID: 38855109 PMCID: PMC11157123 DOI: 10.3389/fimmu.2024.1393939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Novel therapies for 3L+ relapsed/refractory (r/r) follicular lymphoma (FL) have been approved recently by the US Food and Drug Administration including anti-CD19 CAR-T therapies such as axicabtagene ciloleucel (axi-cel) and CD20 × CD3 T-cell-engaging bispecific monoclonal antibodies such as mosunetuzumab (mosun). The objective of this study was to assess the cost-effectiveness of axi-cel compared to mosun in 3L+ r/r FL patients from a US third-party payer perspective. Methods A three-state (progression-free, progressed disease, and death) partitioned-survival model was used to compare two treatments over a lifetime horizon in a hypothetical cohort of US adults (age ≥18) receiving 3L+ treatment for r/r FL. ZUMA-5 and GO29781 trial data were used to inform progression-free survival (PFS) and overall survival (OS). Mosun survival was modeled via hazard ratios (HRs) applied to axi-cel survival curves. The PFS HR value was estimated via a matching-adjusted indirect comparison (MAIC) based on mosun pseudo-individual patient data and adjusted axi-cel data to account for trial populations differences. One-way sensitivity analysis (OWSA) and probabilistic sensitivity analyses (PSA) were conducted. Scenario analyses included: 1) the mosun HRs were applied to the weighted (adjusted) ZUMA-5 24-month data to most exactly reflect the MAIC, 2) mosun HR values were applied to axi-cel 48-month follow-up data, and 3) recent axi-cel health state utility values in diffuse large B-cell lymphoma patients. Results The analysis estimated increases of 1.82 LY and 1.89 QALY for axi-cel compared to mosun. PFS for axi-cel patients was 6.42 LY vs. 1.60 LY for mosun. Increase of $257,113 in the progression-free state was driven by one-time axi-cel treatment costs. Total incremental costs for axi-cel were $204,377, resulting in an ICER of $108,307/QALY gained. The OWSA led to ICERs ranging from $240,255 to $75,624, with all but two parameters falling below $150,000/QALY. In the PSA, axi-cel had an 64% probability of being cost-effective across 5,000 iterations using a $150,000 willingness-to-pay threshold. Scenarios one and two resulted in ICERs of $105,353 and $102,695, respectively. Discussion This study finds that axi-cel is cost-effective compared to mosun at the commonly cited $150,000/QALY US willingness-to-pay threshold, with robust results across a range of sensitivity analyses accounting for parameter uncertainty.
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MESH Headings
- Humans
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/economics
- Lymphoma, Follicular/mortality
- Cost-Benefit Analysis
- United States
- Biological Products/therapeutic use
- Biological Products/economics
- Male
- Antibodies, Bispecific/therapeutic use
- Antibodies, Bispecific/economics
- Female
- Immunotherapy, Adoptive/economics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/economics
- Middle Aged
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Agents, Immunological/economics
- Adult
- Quality-Adjusted Life Years
- Neoplasm Recurrence, Local/drug therapy
- Aged
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Affiliation(s)
| | | | | | | | - Brett Doble
- Kite, A Gilead Company, Santa Monica, CA, United States
| | - Anik R. Patel
- Kite, A Gilead Company, Santa Monica, CA, United States
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Oluwole OO, Ray MD, Rosettie KL, Ball G, Jacob J, Bilir SP, Patel AR, Jacobson CA. Cost-Effectiveness of Axicabtagene Ciloleucel for Adult Patients With Relapsed or Refractory Follicular Lymphoma in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02334-9. [PMID: 38641058 DOI: 10.1016/j.jval.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES The results of a recent single-arm trial (ZUMA-5) of axicabtagene ciloleucel (axi-cel) for relapsed/refractory (r/r) follicular lymphoma (FL) demonstrated high rates of durable response and tolerable toxicity among treated patients. To quantify the value of axi-cel compared with standard of care (SOC) to manage r/r FL patients who have had at least 2 prior lines of systemic therapy (3L+), a cost-effectiveness model was developed from a US third-party payer perspective. METHODS A 3-state partitioned-survival cost-effectiveness model was developed with a lifetime horizon. Patient-level analyses of the 36-month ZUMA-5 (axi-cel) and SCHOLAR-5 (SOC) studies were used to extrapolate progression-free and overall survivals. After 5 years of survival, an estimated 40% of the modeled population was assumed to experience long-term remission based on literature. Results include the incremental cost-effectiveness ratio (ICER) measured as incremental cost per quality-adjusted life year (QALY) gained. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed. All outcomes were discounted 3% per year. RESULTS Axi-cel led to an increase of 4.28 life-years, 3.64 QALYs, and a total cost increase of $321 192 relative to SOC, resulting in an ICER of $88 300 per QALY. Across all parameters varied in the one-way sensitivity analysis, the ICER varied between $133 030 and $67 277. In the probabilistic sensitivity analysis, axi-cel had a 99% probability of being cost-effective across 5000 iterations using a $150 000 willingness-to-pay threshold. CONCLUSIONS Given the robustness of the model results and sensitivity analyses, axi-cel is expected to be a cost-effective treatment in 3L+ r/r FL.
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Affiliation(s)
- Olalekan O Oluwole
- Vanderbilt University Medical Center, School of Medicine, Nashville, TN, USA.
| | | | | | - Graeme Ball
- Kite, A Gilead Company, Santa Monica, CA, USA
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Contributions of cancer treatment, comorbidities, and obesity to aging-related disease risks among non-Hodgkin lymphoma survivors. Cancer Causes Control 2023; 34:171-180. [PMID: 36414860 DOI: 10.1007/s10552-022-01652-0] [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: 03/14/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE It is unknown whether cancer treatment contributes more to long-term disease risk than lifestyle factors and comorbidities among B-cell non-Hodgkin lymphoma (B-NHL) survivors. METHODS B-NHL survivors were identified in the Utah Cancer Registry from 1997 to 2015. Population attributable fractions (PAF) were calculated to assess the role of clinical and lifestyle factors for six cardiovascular, pulmonary, and renal diseases. RESULTS Cancer treatment contributed to 11% of heart and pulmonary conditions and 14.1% of chronic kidney disease. Charlson Comorbidity Index (CCI) at baseline contributed to all six diseases with a range of 9.9% of heart disease to 26.5% of chronic kidney disease. High BMI at baseline contributed to 18.4% of congestive heart failure and 7.9% of pneumonia, while smoking contributed to 4.8% of COPD risk. CONCLUSION Cancer treatment contributed more to heart disease, COPD, and chronic kidney disease than lifestyle factors and comorbidities among B-NHL survivors. High BMI at baseline contributed more to congestive heart failure and pneumonia than cancer treatment, whereas smoking at baseline was not a major contributor in this B-NHL survivor cohort. Baseline comorbidities consistently demonstrated high attributable risks for these diseases, demonstrating a strong association between preexisting comorbidities and aging-related disease risks.
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Goldman ML, Mao JJ, Strouse CS, Chen W, Rupji M, Chen Z, Maurer MJ, Calzada O, Churnetski M, Flowers CR, Cerhan JR, Link BK, Thompson CA, Cohen JB. Surveillance imaging during first remission in follicular lymphoma does not impact overall survival. Cancer 2021; 127:3390-3402. [PMID: 34157780 DOI: 10.1002/cncr.33660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/09/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although many patients with follicular lymphoma (FL) undergo routine radiographic surveillance during their first remission, no consensus exists on the modality, duration, frequency, or need for routine imaging studies. The authors retrospectively examined the effect of surveillance imaging on relapse detection and overall survival (OS) in patients with FL. METHODS Patients with newly diagnosed FL who had a response to induction therapy were identified from the Lymphoid Malignancies Enterprise Architecture Database (LEAD) at Emory University and from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic. Patients were evaluated for both relapse and method of relapse detection (ie, clinical concerns vs radiologic detection through surveillance imaging in an asymptomatic patient). RESULTS Of 148 patients in the LEAD cohort, 55 (37%) relapsed, and the majority (n = 35; 64%) of relapses were detected clinically. In the MER cohort, 63 of 177 relapses (54%) were detected clinically. There was no significant difference in OS from the date of diagnosis between the 2 methods of relapse detection in the LEAD (hazard ratio [HR], 0.61; 95% CI, 0.13-2.94; P = .54) and MER (HR, 1.02; 95% CI, 0.47-2.21; P = .96) cohorts. Similarly, there was no significant difference in OS from the date of relapse between the 2 methods of relapse detection in the LEAD (HR, 0.47; 95% CI, 0.10-2.27; P = .35) and MER (HR, 1.02; 95% CI, 0.47-2.21; P = .96) cohorts. CONCLUSIONS These findings suggest a limited role for routine surveillance imaging in patients with FL who complete front-line therapy. Future studies should evaluate which patients may benefit from a more aggressive surveillance approach and should explore novel methods of relapse detection.
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Affiliation(s)
- Max L Goldman
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Jimmy J Mao
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher S Strouse
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, Iowa
| | - Wanqi Chen
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Manali Rupji
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Zhengjia Chen
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | | | - Oscar Calzada
- Department of Hematology and Medical Oncology, Emory University-Winship Cancer Institute, Atlanta, Georgia
| | - Michael Churnetski
- Department of Hematology and Medical Oncology, Emory University-Winship Cancer Institute, Atlanta, Georgia
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Emory University-Winship Cancer Institute, Atlanta, Georgia
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Brian K Link
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, Iowa
| | | | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Emory University-Winship Cancer Institute, Atlanta, Georgia
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Lakhotia R, Roschewski M. Circulating tumour DNA in B-cell lymphomas: current state and future prospects. Br J Haematol 2021; 193:867-881. [PMID: 33550600 DOI: 10.1111/bjh.17251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
Circulating tumour DNA (ctDNA) is a highly versatile analyte and an emerging biomarker for detection of tumour-specific sequences in lymphoid malignancies. Since ctDNA is derived from tumour cells throughout the body, it overcomes fundamental limitations of tissue biopsies by capturing the complete molecular profile of tumours, including those from inaccessible anatomic locations. Assays for ctDNA are minimally invasive and serial sampling monitors the effectiveness of therapy and identifies minimal residual disease below the detection limit of standard imaging scans. Dynamic changes in ctDNA levels measure real-time tumour kinetics, and early reductions in ctDNA during treatment correlate with clinical outcomes in multiple B-cell lymphomas. After therapy, ctDNA can effectively discriminate between patients who achieved a complete molecular remission from those with residual treatment-resistant disease. Serial monitoring of ctDNA after therapy can detect early molecular relapse and identify drug-resistant clones that harbour targetable mutations. In order for ctDNA to reach its full potential, the standardization and harmonization of the optimal pre-analytical and analytical techniques for B-cell lymphomas is a critically necessary requirement. Prospective validation of ctDNA within clinical studies is also required to determine its clinical utility as an adjunctive decision-making tool.
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Affiliation(s)
- Rahul Lakhotia
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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7
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Spectrum of imaging findings in AIDS-related diffuse large B cell lymphoma. Insights Imaging 2020; 11:67. [PMID: 32430699 PMCID: PMC7237590 DOI: 10.1186/s13244-020-00871-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/06/2020] [Indexed: 02/08/2023] Open
Abstract
Lymphoma in HIV-infected patients is AIDS defining. This is the second most common AIDS defining malignancy after Kaposi's sarcoma. Development of lymphoma in HIV patients is related to immunosuppression and high viral load. Co-infection with other lymphotrophic viruses especially EBV is also strongly associated with development of lymphoma in HIV patients. Despite advances in HAART therapy, incidence of diffuse large B cell lymphoma in HIV-infected patients remains significantly higher than in the general population.Early diagnosis is challenging due to presence of opportunistic infections and atypical presentation of the lymphoma in this subset of patients. Atypical imaging findings are not unusual, and the diagnosis of lymphoma on imaging is on many occasions unexpected as the patient would ideally be initially investigated for presumed opportunistic infection.Lymphoma treatment approaches in HIV patients are complicated by comorbidity with opportunistic infections and performance status of the patients. Treatment failure and early relapse are also common in AIDS-related lymphoma. This review article highlights the common and unusual multimodality imaging findings in HIV-associated lymphoma.
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Glober G, Gunther J, Fang P, Milgrom S, Korivi BR, Jensen CT, Wagner-Bartak NA, Ahmed S, Lee HJ, Nair R, Steiner R, Parmar S, Iyer S, Westin J, Fayad L, Rodriguez MA, Neelapu S, Nastoupil L, Flowers CR, Dabaja BS, Pinnix CC. Imaging Surveillance of Limited-stage Classic Hodgkin Lymphoma Patients After PET-CT-documented First Remission. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:533-541. [PMID: 32291233 PMCID: PMC10071957 DOI: 10.1016/j.clml.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Early stage Hodgkin lymphoma (ESHL) is highly curable; however, 10% to 15% of patients experience relapse. We examined the utilization of follow-up imaging for patients with ESHL who achieved a metabolic complete response after upfront therapy. MATERIALS AND METHODS The records of adult patients treated at a single institution between 2003 and 2014 were reviewed. Positron emission tomography-computed tomography (PET-CT) and CT scan frequency was quantified during the 2 years following treatment and subsequent visits beyond 2 years. RESULTS The study cohort contained 179 patients. The median age was 31 years; bulky disease was present in 30%. ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or AVD (doxorubicin, vinblastine, and dacarbazine) was given in 97%; 75% received radiation therapy. At a median follow-up of 6.9 years, the 5-year progression-free and overall survival rates were 93.7% and 98.1%, respectively. Relapse occurred in 5% (n = 9) of patients at a median of 9.1 months (range, 4.6-27.2 months) from therapy. Two patients presented with symptoms prompting imaging in follow-up. Within 2 years after therapy, 376 PET-CT scans and 3325 CT scans were performed, yielding an average of 2.1 PET-CTs and 18.6 CTs per patient. Of the initial 179 patients, 113 had follow-up conducted beyond 2 years post-therapy; an average of 2.7 PET-CTs and 33.2 CTs were performed. In the 2-year post-therapy period, 463 scans were performed per relapse detected. CONCLUSION In this cohort of patients with ESHL who responded completely to frontline therapy, the relapse rate was low. Routine imaging surveillance lacks clinical benefit in this patient population.
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Affiliation(s)
- Gordon Glober
- University of Central Florida College of Medicine, Orlando, FL
| | - Jillian Gunther
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Penny Fang
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Sarah Milgrom
- Department of Radiation Oncology, University of Colorado, Denver, CO
| | - Brinda Rao Korivi
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX
| | - Corey T Jensen
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX
| | | | - Sairah Ahmed
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Hun Ju Lee
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Ranjit Nair
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Raphael Steiner
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Simrit Parmar
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Swaminathan Iyer
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Jason Westin
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Luis Fayad
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - M Alma Rodriguez
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Sattva Neelapu
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Loretta Nastoupil
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | | | - Bouthaina S Dabaja
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Chelsea C Pinnix
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX.
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Harkins RA, Chang A, Patel SP, Lee MJ, Goldstein JS, Merdan S, Flowers CR, Koff JL. Remaining challenges in predicting patient outcomes for diffuse large B-cell lymphoma. Expert Rev Hematol 2019; 12:959-973. [PMID: 31513757 PMCID: PMC6821591 DOI: 10.1080/17474086.2019.1660159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma and is an aggressive malignancy with heterogeneous outcomes. Diverse methods for DLBCL outcomes assessment ranging from clinical to genomic have been developed with variable predictive and prognostic success.Areas covered: The authors provide an overview of the various methods currently used to estimate prognosis in DLBCL patients. Models incorporating cell of origin, genomic features, sociodemographic factors, treatment effectiveness measures, and machine learning are described.Expert opinion: The clinical and genetic heterogeneity of DLBCL presents distinct challenges in predicting response to therapy and overall prognosis. Successful integration of predictive and prognostic tools in clinical trials and in a standard clinical workflow for DLBCL will likely require a combination of methods incorporating clinical, sociodemographic, and molecular factors with the aid of machine learning and high-dimensional data analysis.
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Affiliation(s)
- R. Andrew Harkins
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | - Andres Chang
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
| | | | - Michelle J. Lee
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | | | - Selin Merdan
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
- Georgia Institute of Technology, Atlanta, Georgia 30332-0002, USA
| | | | - Jean L. Koff
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
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10
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Harkins RA, Patel SP, Flowers CR. Cost burden of diffuse large B-cell lymphoma. Expert Rev Pharmacoecon Outcomes Res 2019; 19:645-661. [PMID: 31623476 DOI: 10.1080/14737167.2019.1680288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma and is a clinically heterogeneous disease. Treatment pathways for DLBCL are diverse and integrate established and novel therapies.Areas covered: We review the cost burden of DLBCL and the cost-effectiveness of DLBCL management including precision and cellular medicine. We utilized Medical Subject Heading (MeSH) terms and keywords to search the National Library of Medicine online MEDLINE database (PubMed) for articles related to cost, cost burden, and cost-of-illness of DLBCL and cost-effectiveness of DLBCL management strategies published in English as of June 2019.Expert commentary: Available and developing DLBCL therapies offer improved outcomes and often curative treatment at considerable financial expense, and the total cost burden for DLBCL management is substantial for patients and the healthcare system. In the era of personalized medicine, CAR T cells and targeted therapies provide exciting avenues for current and future DLBCL care and can further increase treatment cost. Determinations of cost and cost-effectiveness in DLBCL treatment pathways should continue to guide care providers and systems in identifying cost reduction strategies to provide appropriate therapies to the greatest number of patients in treating DLBCL.
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Affiliation(s)
- R Andrew Harkins
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sharvil P Patel
- Department of Quantitative Theories and Methods, Emory University, Atlanta, GA, USA
| | - Christopher R Flowers
- Department of Hematology and Oncology, Winship Research Informatics Shared Resource Emory University School of Medicine Winship Cancer Institute, Atlanta, GA, USA
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Çağlayan Ç, Goldstein JS, Ayer T, Rai A, Flowers CR. A population-based multistate model for diffuse large B-cell lymphoma-specific mortality in older patients. Cancer 2019; 125:1837-1847. [PMID: 30707765 PMCID: PMC6509004 DOI: 10.1002/cncr.31981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/17/2018] [Accepted: 12/07/2018] [Indexed: 12/13/2022]
Abstract
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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Affiliation(s)
- Çağlar Çağlayan
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Turgay Ayer
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Ashish Rai
- Outcomes Research, Surveillance and Health Services Research Program, American Cancer Society Inc, Atlanta, Georgia
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Islam P, Goldstein J, Flowers CR. PET-derived tumor metrics predict DLBCL response and progression-free survival. Leuk Lymphoma 2019; 60:1965-1971. [PMID: 30714446 DOI: 10.1080/10428194.2018.1562181] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
[18F] fluorodeoxyglucose (FDG) - positron emission tomography (PET)/computed tomography (CT) is used to stage and assess response in diffuse large B-cell lymphoma (DLBCL), though the prognostic value of tumor metrics calculated from interim scans remains unsolved. We investigated the predictive value of interim and end-of-treatment (EOT) metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on progression-free survival (PFS) at 24 months in patients with DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Controlling for pretreatment MTV, a positive interim MTV was highly correlated with (0.86) and a significant predictor of a positive EOT MTV (p = .03). Interim MTV > 0 (HR 5.51, CI 1.13, 26.79) and EOT MTV > 4.68 (HR 10.75, CI 1.31, 105.48) were significant predictors of PFS24. Our data show PET-derived metrics of pretreatment and interim MTV offer significant predictive value for EOT response and PFS, and can guide future response-adapted treatment approaches for DLBCL patients that build on the R-CHOP backbone.
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Affiliation(s)
- Prioty Islam
- a Winship Cancer Institute , Emory University , Atlanta , GA , USA
| | - Jordan Goldstein
- a Winship Cancer Institute , Emory University , Atlanta , GA , USA
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13
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18 F-FDG PET/TC con contraste intravenoso en el seguimiento estandarizado de pacientes con linfoma. Rev Esp Med Nucl Imagen Mol 2018; 37:151-155. [DOI: 10.1016/j.remn.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/31/2017] [Accepted: 09/08/2017] [Indexed: 11/24/2022]
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14
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García Vicente A, Talavera Rubio M, Dominguez Ferreras E, Calle Primo C, Amo-Salas M, Tello Galán M, Jimèc)nez Londoño G, Jimèc)nez Aragón F, Hernández Ruiz B, Soriano Castrejón Á. 18 F-FDG PET/contrast enhanced CT in the standard follow-up of patients with lymphoma. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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McCoy RG. Searching for Evidence-Based Reassurance Where None Could Be Found. J Clin Oncol 2018; 36:1266-1267. [PMID: 29389228 DOI: 10.1200/jco.2017.76.5677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Hiniker SM, Hoppe RT. Post-treatment surveillance imaging in lymphoma. Semin Oncol 2018; 44:310-322. [PMID: 29580433 DOI: 10.1053/j.seminoncol.2018.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 01/17/2023]
Abstract
Appropriate post-treatment management of patients with lymphoma has been controversial, with imaging frequently performed as post-treatment surveillance. The goal of post-treatment imaging is to identify relapse prior to clinical symptoms, when the burden of disease is lower and the possibility of effective salvage therapy and cure are greater. However, little data exist to support the performance of surveillance imaging after completion of treatment, with the vast majority of studies suggesting there is no clinical benefit to surveillance imaging in asymptomatic patients. Ongoing efforts seek to identify a subset of patients with a higher risk of relapse that might benefit from surveillance imaging, though financial and other costs associated with imaging are non-negligible and must be considered. Here we summarize the current data regarding post-treatment surveillance imaging in lymphoma.
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Affiliation(s)
- Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, CA.
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, CA
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17
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Chasty B, Patterson M, Murray LJ, Johnson R, Thomas E, Gilson D, Burton C, Prestwich RJD. Lack of effectiveness of routine clinic and blood test-based follow-up for diffuse large B cell lymphoma. Br J Haematol 2017; 182:138-140. [PMID: 28485468 DOI: 10.1111/bjh.14745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Beth Chasty
- University of Leeds School of Medicine, Leeds, UK
| | | | - Louise J Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Rod Johnson
- Department of Haematology, Leeds Cancer Centre, Leeds, UK
| | - Emma Thomas
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Di Gilson
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Cathy Burton
- Department of Haematology, Leeds Cancer Centre, Leeds, UK
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