Management of limited-stage Hodgkin lymphoma

Hodgkin lymphoma (HL) is a rare type of B-cell malignancy with bimodal age distribution targeting young adults and elderly. Prognostic models are available to identify risk of recurrence and response to treatment. Currently, positron emission tomography scanning is most useful in optimizing therapy. Outcomes are generally excellent with standard chemotherapy or combined modality therapy. Balancing efficacy and the risk of late effects in Hodgkin lymphoma is essential, including early detection of potential complications. Incorporation of novel therapies such as brentuximab vedotin and checkpoint inhibitors are being explored in the frontline setting, having already demonstrated improved survival and tolerable toxicity in advanced HL. Furthermore, the addition of these agents have the potential to transform treatment paradigms for early-stage HL and may result in improved outcomes with decreased risks of late toxicities that continue to afflict long-term survivors. However, the patient population, sequencing, and combinations with cytotoxic chemotherapy all remain still standing questions as results of current and upcoming randomized trials are awaited. In this article, we discuss the current data on the approach to initial treatment of early-stage classical HL, review toxicity profiles, and examine upcoming novel therapy trials.

Cardiac Graft Versus Host Disease: A Rare or Underrecognized Pathology?

Allogeneic hematopoietic stem cell transplantation is a potentially curative procedure for a variety of hematologic and immunologic disorders. Despite the powerful therapeutic potential, both acute, and chronic toxicities including graft versus host disease (GVHD) and cardiovascular disease can lead to significant short- and long-term morbidity and mortality. While GVHD can affect any organ, cardiac involvement is rarely described in the literature. In this review, we review available literature, and allude to pathophysiology and therapeutic approaches in cardiac GVHD.

Clinical relevance of MYC/BCL2 expression and cell of origin in patients with diffuse large b-cell lymphoma treated with autologous transplant

Dual expression of MYC and BCL2 proteins (double-expressor lymphoma [DEL]) as well as cell of origin (COO) are important prognostic factors in patients with diffuse large B-cell lymphoma (DLBCL) after conventional chemotherapy. We studied the prognostic impact of DEL and COO in patients with relapsed DLBCL treated with autologous stem cell transplant (ASCT). Three-hundred and three patients with stored tissue samples were identified. Classification was successful in 267 patients: 161 (60%) were DEL/non-double hit (DHL), 98 (37%) were non-DEL/non-DHL, and 8 (3%) were DEL/DHL. Compared to non-DEL/non-DHL, DEL/DHL had worse overall survival while DEL/non-DHL did not significantly differ in overall survival. On multivariable analysis, DEL/DHL, age >60 years, and >2 prior therapies, but not COO, were important prognostic factors for overall survival. When we explored the interaction of COO and BCL2 expression, patients with germinal center B-cell (GCB)/BCL2 (+) had inferior progression-free survival (PFS) compared to GCB/BCL2 (-) patients (HR, 4.97; P = 0.027). We conclude that the DEL/non-DHL and non-DEL/non-DHL subtypes of DLBCL have similar survival after ASCT. The negative impact of GCB/BCL2 (+) on PFS warrants future trials targeting BCL2 after ASCT. The inferior outcomes in DEL/DHL need to be verified in a larger number of patients.

Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation

AIMS

Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT.

METHODS AND RESULTS

The National Inpatient Sample (2016-19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9-3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55-5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6-2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54-7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17-18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56-4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79-3.55; P < 0.001) and cost of care (+67 529; 36 630-98 427; P < 0.001).

CONCLUSION

Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.

Impact of Race and Age and their Interaction on Survival Outcomes in Patients With Diffuse Large B-Cell Lymphoma

BACKGROUND

Advances in treatment for patients with Diffuse Large B-Cell Lymphoma (DLBCL) have led to improved patient outcomes but the magnitude of these disparities remains understudied with regards to improved survival outcomes. We sought to describe changes in DLBCL survival trends over time and explore potential differential survival patterns by patients' race/ethnicity and age.

METHODS

We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with DLBCL from 1980 to 009 and determined 5-year survival outcomes for all patients, categorizing patients by year of diagnosis. We used descriptive statistics and logistic regression, adjusting for stage and year of diagnosis, to describe changes in 5-year survival rates over time by race/ethnicity and age.

RESULTS

We identified 43,564 patients with DLBCL eligible for this study. Median age was 67 years (ages: 18-64 = 44.2%, 65-79 = 37.1%, 80 + = 18.7%). Most patients were male (53.4%) and had advanced stage III/IV disease (40.0%). Most patients were White race (81.4%), followed by Asian/Pacific Islander (API) (6.3%), Black (6.3%), Hispanic (5.4%), and American Indian/Alaska Native (AIAN) (0.05%). Overall, the 5-year survival rate improved from 35.1% in 1980 to 52.4% in 2009 across all races and age groups (odds ratio [OR] for 5-year survival with increasing year of diagnosis = 1.05, P < .001). Patients in racial/ethnic minority groups (API: OR = 0.86, P < .0001; Black: OR = 0.57, P < .0001; AIAN: OR = 0.51, P = .008; Hispanic: 0.76, P = 0.291) and older adults (ages 65-79: OR = 0.43, P < .0001; ages 80+: OR = 0.13, P < .0001) had lower 5-year survival rates after adjusting for race, age, stage, and diagnosis year. We found consistent improvement in the odds of 5-year survival for year of diagnosis across all race and ethnicity groups (White: OR = 1.05, P < .001; API: OR = 1.04, P < .001; Black: OR = 1.06, p<.001; AIAN: OR = 1.05, P < .001; Hispanic: OR = 1.05, P < .005) and age groups (ages 18-64: OR = 1.06, P < .001; ages 65-79: OR = 1.04, P < .001; ages 80+: OR = 1.04, P < .001).

CONCLUSION

Patients with DLBCL experienced improvements in 5-year survival rates from 1980 to 2009, despite persistently lower survival among patients in racial/ethnic minority groups and older adults.

Trends in the improvement in survival among patients with diffuse large B-cell lymphoma (DLBCL)

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Background: Advances in treatment for patients with DLBCL have led to improved patient outcomes, but whether disparities exist with regards to improved survival outcomes remains understudied. We sought to describe changes in DLBCL survival rates over time and explore potential differential survival patterns by patients’ race and age. Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with DLBCL from 1980-2009 and determined 5-year survival rates for all patients, categorizing patients by year of diagnosis. We used descriptive statistics and logistic regression, adjusting for stage and year of diagnosis, to describe changes in 5-year survival rates over time by race/ethnicity and age. Results: We identified 43,564 patients with DLBCL eligible for this study (median age 67 years [ages: 18-64 = 44.2%, 65-79 = 37.1%, 80+ = 18.7%], 53% male, 40% stage III/IV). Most were White race (81.4%), followed by race/ethnic groups of Asian/Pacific Islander (API) (6.3%), Black (6.3%), Hispanic (5.4%), and American Indian/Alaska Native (AIAN) (0.05%). Overall, the 5-year survival rate improved from 35.1% in 1980 to 52.4% in 2009 across all patients (odds ratio (OR) for 5-year survival with increasing year of diagnosis = 1.05, p <.001). Patients in race/ethnic minority groups (API: OR = 0.86, p <.0001; Black: OR = 0.57, p <.0001; AIAN: OR = 0.51, p =.008) and older adults (ages 65-79: OR = 0.43, p <.0001; ages 80+: OR = 0.13, p <.0001) had worse 5-year survival rates adjusting for race, age, stage, and diagnosis year. We found consistent improvement in the odds of 5-year survival for year of diagnosis across all race and ethnicity groups (White: OR = 1.05, p <.001; API: OR = 1.04, p <.001; Black: OR = 1.06, p <.001; Hispanic: OR = 1.05, p <.005; AIAN: OR = 1.05, p <.001) and age groups (ages 18-64: OR = 1.06, p <.001; ages 65-79: OR = 1.04, p <.001; ages 80+: OR = 1.04, p <.001). Conclusions: In this analysis of SEER data, we found that patients with DLBCL experienced improvements in 5-year survival rates from 1980 to 2009, despite ongoing disparities demonstrating worse survival among patients in race/ethnic minority groups and older adults. Notably, we did not find differential improvement in the odds of 5-year survival within subgroups of race and age, underscoring the need for ongoing investigations to address disparities in cancer care delivery and outcomes.

The Role of Cytoreductive Nephrectomy and Targeted Therapy on Outcomes of Patients With Metastatic Sarcomatoid Renal Cell Carcinoma: A Population-Based Analysis

Sarcomatoid renal cell carcinoma (sRCC) is a rare but aggressive form of kidney cancer with a poor prognosis. Despite recent advances in therapies for kidney cancers, an effective management strategy for sRCC is uncertain. We evaluated the impact of targeted therapy and cytoreductive nephrectomy (CN) on survival outcomes of patients with metastatic sRCC. We identified patients diagnosed with sRCC between January 1, 1973, and December 31, 2014, within the Surveillance, Epidemiology and End Results (SEER) database. Patients with metastatic sRCC were stratified based on the era of diagnosis (before or after the introduction of targeted systemic therapy in 2006) and the status of CN. Cancer-specific survival (CSS) and overall survival (OS) were analyzed. Data of 993 patients with metastatic sRCC were available for analysis. The median age was 62 years. Most patients were male (69%), Caucasian (71%), and were diagnosed in the targeted therapy era (83%); 53% of patients underwent CN. CSS and OS of the whole cohort were 5.0 months and 4.0 months, respectively. While the introduction of targeted therapy did not improve outcomes, CN improved CSS and OS in both pre-targeted therapy and targeted therapy era. On multivariable analysis, CN was a predictor of an improved CSS (hazard ratio [HR] 0.54, p < 0.0001) and OS (HR 0.51, p < 0.0001). Among other factors, older age at diagnosis, higher T stages, and node positivity were associated with worse outcomes. Our results showed that the introduction of targeted therapy did not improve outcomes in patients with metastatic sRCC. CN improved survival in both pre-targeted and targeted therapy eras.

Reappraising the Role of Allogeneic Hematopoietic Stem Cell Transplantation in Relapsed and Refractory Hodgkin’s Lymphoma: Recent Advances and Outcomes

Hodgkin’s lymphoma is a rare yet highly curable disease in the majority of patients treated with modern chemotherapy regimens. For patients who fail to respond to or relapse after initial systemic therapies, treatment with high-dose chemotherapy and autologous hematopoietic stem cell transplantation can provide a cure for many with chemotherapy-responsive lymphoma. Patients who relapse after autologous transplant or those with chemorefractory disease have poor prognosis and represent a high unmet need. Allogeneic hematopoietic stem cell transplantation provides a proven curative therapy for these patients and should be considered, especially in young and medically fit patients. The use of newer agents in this disease such as brentuximab vedotin and immune checkpoint inhibitors can help bring more patients to transplantation and should be considered as well.

Real-world long-term outcomes in multiple myeloma with VRD induction, Mel200-conditioned auto-HCT, and lenalidomide maintenance

Standard-of-care for newly-diagnosed, autologous hematopoietic stem cell transplantation (auto-HCT)-eligible, multiple myeloma (MM) patients includes bortezomib, lenalidomide, and dexamethasone (VRD) induction followed by melphalan 200 mg/m² (Mel200)-conditioned auto-HCT and lenalidomide maintenance. We completed a retrospective case series assessing outcomes of 187 MM patients who received this regimen at our institution. The 100-day non-relapse mortality incidence was zero. Before auto-HCT, 9.6 and 52.9% of patients achieved a complete response (CR) or ≥ very good partial response (VGPR), respectively. At day-100 post-transplant, 29.4 and 74.9% had achieved a CR/stringent-CR (sCR) or ≥ VGPR, respectively. At the last evaluation, 57.2% of patients had CR/sCR and 87.1% had ≥ VGPR. Median follow-up, progression-free survival (PFS), and overall survival (OS) were 63.2, 50, and 101.7 months, respectively. The 5-year PFS and OS were 43.1 and 79%. High-risk cytogenetics was associated with worse outcomes. This study illustrates that VRD induction, Mel200-conditioned auto-HCT, and lenalidomide maintenance are associated with good outcomes in MM.

CAR-T in B-Cell Lymphomas: The Past, Present, and Future

Aggressive B-cell lymphomas including diffuse large B-cell lymphoma make up the majority of non-Hodgkin's lymphoma globally. While more than half of these patients can be cured with modern chemoimmunotherapy regimens, the outcomes of relapsed or refractory disease continue to be very poor. Despite significant developments in targeted cancer therapies and immuno-oncology, the attainability of a cure remained an elusive goal outside of incorporating high doses of chemotherapy followed by hematopoietic stem cell transplantation, for patients who have chemosensitive disease. The development of chimeric antigen receptor T-cell therapy changed that paradigm and introduced a new field of therapeutic possibilities for these patients. In this review, we will discuss the current state of this therapeutic modality in B-cell lymphomas and provide opinions on where future efforts need to focus in order to further improve their clinical utility.

Outcomes of cardiac diffuse large B-cell lymphoma (DLBCL) in the rituximab era

Background Cardiac diffuse large B-cell lymphoma (cDLBCL) is an extremely rare disease. Introduction of rituximab has significantly improved survival in non-cardiac DLBCL, but there is limited data regarding the effects on outcomes in cDLBCL. We sought to evaluate the outcomes of cDLBCL in both pre- and rituximab eras. Methods We identified all cDLBCL cases in the Surveillance, Epidemiology and End Results (SEER) registry from 1975 to 2016. We compared survival (overall and lymphoma-specific) of patients diagnosed prior to versus after rituximab approval in 2006. Results A total of 106 patients were included in the final analysis. Median age was 69.5 years, 67% of the patients were white and 64% had local stage I/II disease. 67% of the patients were diagnosed after 2006 and thus belonged to the rituximab era group. Overall, 77% received chemotherapy, 24% had surgery and 15% had radiotherapy. Median overall survival (OS) for the entire cohort was 22 months. Median OS was 16 months (95% CI, 0.55-31) for the pre-rituximab group, versus 26 months (95% CI, 7.5-45) for the rituximab group (p = 0.34). Median lymphoma-specific survival (LSS) was 30 months (95% CI, 8.0-52) for the pre-rituximab group versus 36 months (95% CI, 16-158) for the rituximab group (p = 0.30). OS and LSS were also not significantly different between the two era groups when stratified by chemotherapy. In multivariable analysis, both OS and LSS were associated with lymphoma stage, insurance status and age but not with diagnosis era or chemotherapy. Conclusions Cardiac DLBCLs are rare and affecting mostly the elderly. Younger age, limited disease stage, and having health insurance but not lymphoma diagnosis era were associated with better outcomes.

Perspectives on chemotherapy for the management of double-hit lymphoma

INTRODUCTION

. Unlike most B-cell lymphomas, they have poor response to standard R-CHOP therapy, tend to quickly develop resistance to cytotoxic chemotherapies, and are associated with higher central nervous system (CNS) infiltration. This can lead to increased risk of relapse and worse prognosis. DHL/THL represent a subset of lymphomas with unmet medical need.

AREA COVERED

The authors present the available data for the current treatment regimens including intensive chemotherapy regimens, hematopoietic stem-cell transplantation (HSCT), and CNS prophylaxis. They also discuss treatment for relapsed disease including targeted therapies.

EXPERT OPINION

There is currently no accepted standard of care for DHL/THL. For frontline therapy, we recommend enrollment in a well-designed clinical trial if possible, otherwise DA-EPOCH-R with CNS prophylaxis is a commonly used first-line therapy. The authors recommend close surveillance for patients achieving complete response, but for those who fail to achieve a complete response, then clinical trials, more aggressive salvage chemotherapy regimens, or cellular therapies are usually considered.

Marginal Zone Lymphoma: State-of-the-Art Treatment

OPINION STATEMENT

Despite being the second most common indolent non-Hodgkin's lymphoma (iNHL), marginal zone lymphoma (MZL) remains largely understudied, and given its underlying disease heterogeneity, it is challenging to define a single treatment approach for these patients. For localized disease, local therapy is recommended such as triple therapy for H. pylori in gastric extranodal MZL, splenectomy for splenic MZL, and radiotherapy for nodal MZL. For disseminated disease with low tumor burden, a watch and wait or single-agent rituximab can be used. However, for symptomatic disease, a similar approach to follicular lymphoma (FL) can be used with chemoimmunotherapy approaches such as bendamustine and rituximab. High FDG uptake is not common in MZL and is not diagnostic by itself of transformation to high-grade lymphoma but informs the choice of the site to be biopsied. Transformation into a large B cell lymphoma is treated with R-CHOP-like regimens. Patients with relapsing disease after at least one CD20-based therapy have several recently approved chemotherapy-free options including B cell receptor inhibitors such ibrutinib (approved specifically in MZL) and immunomodulatory agents such as lenalidomide and rituximab (FDA approved in MZL and FL). Phosphoinositide 3-kinase (PI3K) inhibitors have shown excellent activity in iNHL, specifically in MZL, with breakthrough designation status for copanlisib and umbralisib, allowing off label use of this class of agents in clinical practice. With the availability of prospective clinical trials using chemo-free approaches, specifically those targeting abnormal signaling pathways activated in MZL tumors and its microenvironment, treating physicians are encouraged to enroll patients on these clinical trials in order to better understand the underlying biology, mechanisms of response, and resistance to current therapies and help design future rationale combination strategies.

Abstract 4916: Impact of primary organ site on prognosis in extranodal peripheral T cell lymphoma not otherwise specified

Introduction: Peripheral T cell lymphoma, not otherwise specified (PTCL, NOS) is a rare heterogeneous group of diseases that constitutes 25% of T-cell lymphomas. It predominately affects men with a median age of 60 years at presentation. It is known to be an aggressive disease with high risk of relapse and subsequent poor response to systemic therapies. In this study, we sought to investigate the impact of primary site of disease on prognosis in extranodal PTCL, NOS.

Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to identify adult patients (≥20 years) diagnosed with PTCL, NOS between 1973 and 2014. Primary sties excluded were lymph nodes, bone marrow, spleen and skin. All stages of disease were included; treatment effect (surgery, radiation, chemotherapy) was analyzed when available. Sites of disease were grouped into 5 organ systems for convenience. Overall survival (OS) was estimated using the Kaplan-Meier method, and compared using Log-Rank test. Cox proportional hazards models were used for adjusted survival analyses.

Results: Total of 392 patients were included. Median age was 62 years, and majority were male (n=242, 61.7%) Caucasian (n=224, 57.1%), and married (n=231, 58.9%). Gastrointestinal/hepatobiliary site was the most common primary extranodal organ system involved (n=156, 39.8%), followed by head and neck (n=147, 37.5%), thoracic excluding breast (n=42, 10.7%), CNS (n=32, 8.2%), and breasts (n=15, 3.8%). Most patients had stage IV disease (n=116, 29.6%). Total of 137 (34.9%) patients had surgery to the primary site, 94 (24%) had radiation, and 241 (61.5%) received chemotherapy. Median overall survival was 13 (0-252) months, and was statistically different by primary organ system involved (p&lt; 0.001). Gastrointestinal/hepatobiliary group had the worst median survival of only 8 months (95% CI 4.3- 11.6), followed by thoracic [median of 9 months; 95% CI (0.0 - 21.7)], and CNS [median of 12 months; 95% CI (3.5 - 20.4)]. Lymphoma was the most common cause of death (n=166, 42.3%). On univariate analysis, patients who received surgery did not have better survival [HR 0.909; 95% CI (0.70-1.16)]; while patients who received radiation [HR 0.53; 95% CI (0.39-0.71)], or chemotherapy [HR 0.76; 95% CI (0.60-0.98)] had better outcomes. In a multivariate analysis model; stage IV disease and Hispanic race were significantly associated with worse survival; while being married, undergoing radiation or chemotherapy was associated with better survival.

Conclusion: PTCL, NOS is a rare aggressive disease mostly affecting elderly men. Lymphoma involving gastrointestinal /hepatobiliary system is the most common site of primary extranodal disease and portends the worst survival. Patients who received radiation or chemotherapy had better outcomes.

Citation Format: Taha Al-Juhaishi, Arushi Khurana, Danielle Shafer, Victor Yazbeck. Impact of primary organ site on prognosis in extranodal peripheral T cell lymphoma not otherwise specified [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4916.

Prognostic Factors of Malignant Pheochromocytoma and Paraganglioma: A Combined SEER and TCGA Databases Review

Pheochromocytoma (PCC) and paraganglioma (PGL) are rare malignancies while pathogenesis is strongly influenced by genetics. The prognostic factors of these patients remain poorly defined. We aim to study the epidemiology and survival pattern by analyzing the combination of SEER and Cancer Genome Atlas (TCGA) database. Primary outcome was overall survival (OS) and disease specific survival (DSS). Between 1973 and 2013, a total of 1014 patients with PGL or PCC were analyzed. Younger age and female were associated with better outcomes. The incidence of second primary malignancy in PGL/PCC patients was about 14.6%. This population had a significant longer DSS. Other factors, including surgical resection and origin from of aortic/carotid bodies, conferred remarkable survival advantage. In contrast, distant spread portended worse prognosis. Laterality, race, positive serum catecholamine marker did not demonstrate a significant association with OS and DSS. By analyzing TCGA database with total 184 patients were identified. Eighty out of 184 patients (43.5%) had at least one pathogenic mutation. Female had higher ratio of pathogenic mutations than male (58.7% vs. 41.3%) and NF1 mutation was associated with elderly population. SHDB mutation had higher percentage in male. Twenty-nine patients (15.8%) had 2 or more primary. ATRX was the most common oncogenic mutations in metastatic cohort. In conclusion, younger age, female sex, origin from aortic/carotid bodies, complete surgical resection, regional disease, as well as concomitant second primary malignancies were associated with better prognosis. The prognostic value of radiotherapy and oncogenomics warrants further investigation.

Abstract 3304: CNS metastases in prostate cancer: an analysis of SEER database

Metastases to central nervous system (CNS) from various solid tumors, such as lung cancer (40-50%), breast cancer (15-25%) and melanoma (5-20%), are relatively common and confer a poor prognosis. CNS metastases from prostate cancer are uncommon. Due to the rarity of this disease and lack of studies, little is known about the clinical and pathological characteristics as well as outcome of these patients. CNS metastases also have therapeutic implications in terms of targeting hypothalamic-pituitary axis for androgen deprivation as well as CNS penetration of systemic chemotherapy agents. The objective of this study is to analyze clinicopathologic features and outcome of prostate cancer patients with CNS metastases in Survival, Epidemiology, and End Result (SEER) database. Between 2010 and 2015, a total of 23,776 patients with metastatic prostate were identified. Among them, 23,468 cases were adenocarcinoma and 308 cases were prostate cancer with neuroendocrine differentiation. A number of variables, including age, race, prostate-specific antigen (PSA) level, Gleason score, and prior radiotherapy, site of metastases were extracted. Primary outcome were overall survival (OS) and disease specific survival (DSS). CNS metastases were identified in 208 (0.89%) and 11 (3.57%) patients with adenocarcinoma and neuroendocrine tumor, respectively. Majority of patients (56.2%) were 65 years or older. Median OS and DSS were 13 months and 14 months, respectively. In comparison to patients with lymph nodes metastases only (n=8,103), the median OS and DSS were 40 months and 58 months, respectively. In patients with bone dominant metastasis (n=14,407), the median OS and DSS were 27 months and 34 months, respectively. Multivariate analysis identified age was an adverse predictive factor in patients with CNS metastasis. Race, high Gleason score (≥9), high PSA level (≥98ng/ml) and prior radiotherapy were not associated with OS and DSS. In conclusion, CNS metastases are more common in neuroendocrine tumor than in adenocarcinoma of prostate, and it confers poor survival outcome irrespective of histological subtypes. OS and DSS were worse in patients with prostate cancer and CNS metastases compared to those with lymph node metastases only or bone-dominant metastases.

Note: This abstract was not presented at the meeting.

Citation Format: Lin Mei, Taha Al-Juhaishi, Andrew Poklepovic, Asit Paul. CNS metastases in prostate cancer: an analysis of SEER database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3304.

Testicular Swelling as an Initial Presentation of a Patient With Metastatic Gastric Cancer

While signet-ring cell morphology in the testes might represent metastatic spread from an extragonadal adenocarcinoma, a rare variant of primary testicular neoplasms should be considered in a differential diagnoses as was seen in this rare occurrence of a testicular swelling as an initial presentation for a patient with metastatic gastric cancer.

Abstract 596: Impact of histologic type on survival in primary thyroid lymphomas

Background:

Primary Thyroid Lymphoma (PTL) is a rare disease constituting less than 2% of all extranodal lymphomas; and approximately 2-8% of all thyroid malignancies. In this study, we sought to describe the impact of histologic types on survival.

Methods:

The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients (≥18 years) diagnosed with PTL between 1973 and 2014. B-cell and T-cell lymphomas of all stages were included. Overall survival (OS) was estimated using the Kaplan-Meier method, and compared using Log-Rank test. Cox proportional hazards models were used for adjusted survival analyses.

Results:

Total of 2397 patients were included. Median age was 65 years (56-77); majority were female (n=1734, 72%) and caucasian (n=2178, 91%). Diffuse large B cell lymphoma was the most common histology (DLBCL, N=1351, 56%), followed by marginal zone (MZL, N=334, 14%), follicular (FL, N= 214, 8.9%), Burkitt (BL, N=43, 1.8%), chronic/small lymphocytic leukemia/lymphoma (CLL/SLL, N=41, 1.7%), Hodgkin lymphoma (HL, N=33, 1.4%), T cell lymphomas (TCL, N=14, 0.6%), Lymphoplasmocytic lymphoma (LPL, N=11, 0.4%), and Mantle cell (MCL, N=8, 0.3%). 349 patients (14.6 %) were reported with unclear histology. Total of 1502 (63%) had surgery, 1417 (59%) had chemotherapy and 1153 (48%) had radiation. At a median follow-up of 10.5 years, 1187 (50%) patients died. Median overall survival was 11.4 [10.6-12.3; 95% CI] years. Survival was different by histology type (table, P&lt;0.001). Compared with DLBCL, follicular lymphoma (HR 0.72 [0.57-0.92], P=0.008) and MZL (HR 0.62 [0.48-0.78], P&lt;0.001) were associated with lower mortality, independently of age, sex, race, surgery, chemotherapy, radiation and year of diagnosis. Adjusted mortality decreased by a relative 1% annually (HR 0.99 [0.98-0.99], P&lt;0.001).

Conclusion:

PTL is a rare disease mostly affecting elderly caucasian women. Outcomes vary depending on histologic type. Follicular, MZL and Hodgkin's lymphoma seem to have a favorable prognosis.

Overall Survival by HistologyHistologyNumber (%)Mean Survival in Years (95% CI)1-year survival5-year survivalDLBCL1351 (66%)12.6 [11.7-13.4]80%66%Burkitt43 (2.1%)15.9 [13.5-18.3]79%79%CLL/SLL41 (2%)13 [9.5-16.5]78%67%Follicular214 (10.4%)17.8 [15.1-20.6]97%83%Hodgkin33 (1.6%)25 [20-30]94%84%LPL10 (0.5%)14.2 [7.4-21]100%76%MZL334 (16.3%)13 [11.9-14.1]95%83%Mantel-Cell8 (0.4%)8.7 [3.9-13.5]87%56%T-cell14 (0.7%)10.7 [3.9-17.5]70%53%

Citation Format: Taha Al-Juhaishi, Victor Yazbeck. Impact of histologic type on survival in primary thyroid lymphomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 596.

Cardiovascular disease research activity in the Middle East: a bibliometric analysis

OBJECTIVES

The Middle East has a high prevalence of noncommunicable chronic diseases. The objective of this article was to quantify the research activity in cardiovascular disease (CVD) in the Middle East over the last 10 years.

METHODS

A Medline search was conducted using medical subject headings and author affiliation to retrieve research articles published from the Middle East between 2003 and 2012 (inclusive).

RESULTS

Middle Eastern countries produced only 3% of the total number of CVD research articles in the world. However, the overall trend showed an increase in the number of articles over the years, mainly from Turkey and Iran. Within this region, the ratio of CVD to non-CVD publications was highest in Qatar (0.23). Lebanon ranked first in the number of CVD publications per million persons (PMP) averaging 194.2 publications PMP and Turkey ranked highest in the number of CVD publications per US$1000 gross domestic product (GDP) per capita averaging 954 CVD publications per US$1000 GDP per capita.

CONCLUSIONS

Although there has been a drive towards greater publication of CVD papers in the last decade, research activity in the Middle East still lags behinds developed countries. Greater productivity is anticipated to emerge to accompany the recent significant investment in research in Gulf countries.

Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients

Aim

To determine the prevalence of low back pain (LBP), investigate the sociodemographic characteristics of patients with LBP, and examine its association with psychological distress such as anxiety, depression, and somatization.

Subjects and methods

Of the 2742 patients approached, 2180 agreed to participate in this cross-sectional study (79.5% response rate). The survey was conducted among primary health care visitors from March to October 2012 and collected sociodemographic details and LBP characteristics. General Health Questionnaire-12 was used to identify the probable cases. Anxiety was assessed with Generalized Anxiety Disorder-7, depression was assessed with Patient Health Questionnaire-9, and somatization was measured with Patient Health Questionnaire-15.

Results

The study sample consisted of 52.9% males and 47.1% females. The prevalence of LBP was 59.2%, comprising 46.1% men and 53.9% women. LBP was significantly higher in Qataris (57.9%), women (53.9%), housewives (40.1%), and individuals with higher monthly income (53.9%). Somatization (14.9%) was observed more in LBP patients, followed by depression (13.7%) and anxiety disorders (9.5%). The most frequently reported symptoms were “headaches” (41.1%) and “pain in your arms, legs, or joints” (38.5%) in LBP patients with somatization. The most frequent symptoms among depressed LBP patients were “thinking of suicide or wanting to hurt yourself” (51.4%) and “feeling down, depressed, or hopeless” (49.2%). “Not being able to stop or control worrying” (40.2%), “worrying too much about different things” (40.2%), and “feeling afraid as if something awful might happen” (40.2%) were the most common anxiety symptoms in LBP patients. Psychological distress such as anxiety (9.5% versus 6.2%), depression (13.7% versus 8.5%), and somatization (14.9% versus 8.3%) were significantly higher in LBP patients.

Conclusion

The prevalence of LBP in this study sample was comparable with other studies. Furthermore, psychological distress such as anxiety, depression, and somatization were more prevalent in LBP patients compared to patients without LBP.