Temporal trends in treatment and survival of older adult diffuse large B-Cell lymphoma patients in the SEER-Medicare linked database

Shaw, J.; Harvey, Christopher J.; Richards, Catherine; Kim, Christopher

doi:10.1080/10428194.2019.1623886

Cited by 19 publications

(14 citation statements)

References 24 publications

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“…Stratified Kaplan-Meier survival analyses showed worse survival with increasing age, male gender, and use of chemotherapy without R. Such trends were also observed in an US SEER registry study [23]. Association of R-based regimens with higher survival rates has been suggested in earlier reports [4,8,9].…”

Section: Plos Onesupporting

confidence: 69%

“…This analysis classified patient's 1L regimen based on their first treatment during the identification period and required at least 6 months of look-back with a DLBCL diagnosis. Most patients were assumed to be treatment naïve, and based on the 1L regimen distribution, the results were consistent with prior literature [23]. Another limitation was that mortality data were captured only through patient's hospital discharge records, making OS results less robust.…”

Section: Plos Onesupporting

confidence: 55%

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Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma

Tsutsué¹,

Tobinai²,

Yi³

et al. 2020

PLoS ONE

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Limited data are available regarding treatment patterns, healthcare resource utilization (HCRU), treatment costs and clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL) in Japan. This retrospective database study analyzed the Medical Data Vision database for DLBCL patients who received treatment during the identification period from October 1 2008 to December 31 2017. Among 6,965 eligible DLBCL patients, 5,541 patients (79.6%) received first-line (1L) rituximab (R)-based therapy, and then were gradually switched to chemotherapy without R in subsequent lines of therapy. In each treatment regimen, 1L treatment cost was the highest among all lines of therapy. The major cost drivers i.e. total direct medical costs until death or censoring across all regimens and lines of therapy were from the 1L regimen and inpatient costs. During the follow-up period, DLBCL patients who received a 1L R-CHOP regimen achieved the highest survival rate and longest time-to-next-treatment, with a relatively low mean treatment cost due to lower inpatient healthcare resource utilization and fewer lines of therapy compared to other 1L regimens. Our retrospective analysis of clinical practices in Japanese DLBCL patients demonstrated that 1L treatment and inpatient costs were major cost contributors and that the use of 1L R-CHOP was associated with better clinical outcomes at a relatively low mean treatment cost.

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Section: Plos Onesupporting

confidence: 69%

Section: Plos Onesupporting

confidence: 55%

Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma

Tsutsué¹,

Tobinai²,

Yi³

et al. 2020

PLoS ONE

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“…For both autologous HCT and stem cell collection, only incident outcomes were considered. We obtained CPT and ICD codes through a focused literature review, American Society of Transplantation and Cellular Therapy billing guidelines, discussion with billing physicians, and manual review of codes 11 . We used a combination of inpatient and outpatient billing codes to avoid missing outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…We obtained CPT and ICD codes through a focused literature review, American Society of Transplantation and Cellular Therapy billing guidelines, discussion with billing physicians, and manual review of codes. 11 We used a combination of inpatient and outpatient billing codes to avoid missing outcomes. We identified outcomes at any point following the diagnosis of lymphoma.…”

Section: Methodsmentioning

confidence: 99%

Racial and ethnic differences in the utilization of autologous transplantation for lymphoma in the United States

et al. 2021

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Background Racial/ethnic disparities in the utilization of hematopoietic cell transplantation (HCT) have been reported for patients with hematologic malignancies, but population‐based data are lacking for lymphoma patients. The objective of this study was to determine whether racial and ethnic disparities exist in the utilization of autologous HCT for lymphoma in the United States. Method We used Surveillance, Epidemiology, and End Results data linked to Medicare fee‐for‐service claims. We included Medicare beneficiaries aged 66+ years with Hodgkin or Non‐Hodgkin lymphomas diagnosed between 2008 and 2015. The primary outcome was time‐to‐autologous HCT. We used Cox proportional hazards models to estimate racial/ethnic differences in utilization. Missing data were handled using multiple imputation with chained equations. Results We included 40,605 individuals with lymphoma. A total of 452 autologous transplants were performed. In the unadjusted model, Non‐Hispanic Black patients were 51% less likely to receive a transplant than Non‐Hispanic White patients (95% CI, 0.26–0.96; p = 0.04). After adjusting for age at diagnosis and sex, Non‐Hispanic Black patients were 61% less likely to receive a transplant (95% CI, 0.20–0.76; p = 0.01). However, observed differences attenuated and became non‐significant after adjustment for socioeconomic factors (adjusted hazard ratio [aHR], 0.62; 95% CI, 0.32–1.21; p = 0.16) and disease‐specific factors (aHR, 0.58; 95% CI, 0.30–1.12; p = 0.11), separately. In the fully adjusted model, we also did not observe a statistically significant association between Non‐Hispanic Black race/ethnicity and receipt of transplant (aHR, 0.54; 95% CI, 0.28–1.05; p = 0.07). Conclusion In this population‐based cohort study of lymphoma patients, Non‐Hispanic Black patients were less likely to receive autologous HCT compared to Non‐Hispanic White patients, but this difference was partially explained by socioeconomic and disease‐specific factors.

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“…80 years v 71% in patients up to 80 years). 10 Outcomes have been found to be inferior in patients who do not complete R-CHOP therapy. 11 In a retrospective, single-center study of 115 previously untreated patients, Kwak et al 12 identified an actual relative dose intensity of doxorubicin .…”

Section: Introductionmentioning

confidence: 99%

TRAIL Score: A Simple Model to Predict Immunochemotherapy Tolerability in Patients With Diffuse Large B-Cell Lymphoma

Harris¹,

Bataillard

Choi³

et al. 2022

JCO Clinical Cancer Informatics

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PURPOSE Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) represents the standard of care for first-line treatment of diffuse large B-cell lymphoma (DLBCL). However, many patients are unable to tolerate R-CHOP and have inferior outcomes. This study aimed to develop a practical tool to help physicians identify patients with newly diagnosed DLBCL unlikely to tolerate a full course of R-CHOP. METHODS We developed a predictive model (Tolerability of R-CHOP in Aggressive Lymphoma [TRAIL]) on the basis of a training data set from the phase III GOYA trial (obinutuzumab with CHOP v R-CHOP in 1L DLBCL) using a composite binary end point, identifying patients who prematurely stopped or required reductions of R-CHOP. Candidate predictive variables were selected on the basis of known baseline characteristics that contribute to patient frailty, comorbidity, and/or chemotherapy toxicity. TRAIL was developed using an iterative trial-and-error modeling process to fit a logistic regression model. The final model was evaluated for robustness using a GOYA holdout data set and the phase III MAIN (R-CHOP with or without bevacizumab in 1L DLBCL) R-CHOP-21 data set as external validation. RESULTS TRAIL includes four simple predictors available in the routine clinical setting: Charlson Comorbidity Index, presence of cardiovascular disease or diabetes, serum albumin, and creatinine clearance. Model generalization performance estimated by the area under the curve was around or above 0.70 across GOYA training, GOYA holdout, and MAIN data sets. Classifying patients into low-, intermediate- and high-risk categories, the proportion of patients experiencing a tolerability event was 3.3%, 12.4%, and 32.9%, respectively, in GOYA holdout, and 9.7%, 9.7%, and 34.2%, respectively, in MAIN. CONCLUSION TRAIL may be useful as a clinical decision support tool for treatment decisions in patients with DLBCL who may not tolerate standard chemoimmunotherapies.

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Temporal trends in treatment and survival of older adult diffuse large B-Cell lymphoma patients in the SEER-Medicare linked database

Cited by 19 publications

References 24 publications

Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma

Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma

Racial and ethnic differences in the utilization of autologous transplantation for lymphoma in the United States

TRAIL Score: A Simple Model to Predict Immunochemotherapy Tolerability in Patients With Diffuse Large B-Cell Lymphoma

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