Contributions
Abstract: EP519
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Primary refractory disease is a major challenge in patients (pts) with diffuse large B-cell lymphoma (DLBCL), and is commonly defined as disease progression during first-line (1L) therapy or within 6 months (mo) of completing 1L therapy. Poor outcomes in pts with primary refractory DLBCL were reported in SCHOLAR-1, a study based on data primarily from academic centers (Crump, et al. Blood 2017). A limited number of studies have evaluated real-world outcomes of pts with primary refractory DLBCL in the broader healthcare setting. Here, we report the results of real-world data (RWD) analyses from two US sources.
Aims
To describe outcomes of pts with DLBCL receiving second-line (2L) therapy from RWD according to the time from last treatment (TLT), defined by the time from end of 1L to the start of 2L therapy.
Methods
This study used the nationwide Flatiron Health (FH) electronic health record-derived de-identified database and the Surveillance, Epidemiology, and End Results (SEER)-Medicare (SEER-M)-linked database, which combines the SEER Cancer Registry and Medicare claims database. The majority of pts in the FH database originate from community oncology settings; relative community/academic proportions may vary depending on study cohort. The data of pts with DLBCL who received 2L therapy between Jan 2011–Jan 2020 in FH and Jan 2011–Dec 2015 in SEER-M were reviewed. Pts aged ≥18 years (pts in SEER-M were aged >65 years) with DLBCL, who were treated with cyclophosphamide- and doxorubicin-containing regimens in the 1L setting, were included for analysis. For SEER-M, all pts enrolled in fee-for-service Medicare were required to have complete claims. Data of pts who developed a secondary malignancy were censored at the time of the malignancy, and medical review of treatment regimens was performed for the final cohorts. Pts were grouped into three categories of TLT (<6 mo, 6–12 mo and >12 mo), and the impact of TLT was analyzed for association with overall survival (OS), defined by the time from the start of salvage therapy to death.
Results
Overall, 866 pts were included (FH: n=442; SEER-M: n=424) for analysis. Pt characteristics were similar between the cohorts, except median age at diagnosis (FH: 65 years; SEER-M: 74 years). Pts were mostly white (FH: 72.9%; SEER-M: 91.5%), male (FH: 63.1%; SEER-M: 52.1%), with Stage III–IV disease (FH: 64.9%; SEER-M: 69.5%). The most common 2L regimens were: rituximab (R) + carboplatin + etoposide + ifosfamide (39.8% in FH and 7.5% in SEER-M), R + bendamustine (14.0% in FH and 29.2% in SEER-M), and R + gemcitabine + oxaliplatin (8.4% in FH and 12.5% in SEER-M). Using a TLT cut-off of <6 mo, 236 (53.4%) pts in the FH cohort and 197 (45.3%) pts in the SEER-M cohort were classified as primary refractory. In the FH cohort, median OS for TLT <6 mo, 6–12 mo, and >12 mo were 9.1 mo (95% confidence interval [CI]: 8.1–13.1 mo), 20.9 mo (95% CI: 13.7–47.5), and 42.9 mo (95% CI: 22.8–57.3), respectively (Figure). In the SEER-M cohort, median OS for TLT <6 mo, 6–12 mo, and >12 mo were 8.6 mo (95% CI: 6.7–11.4), 11.7 mo (95% CI: 8.8–16 .1), and 18.9 mo (95% CI: 15.7–32.9), respectively.
Conclusion
Our RWD analysis highlights the poor outcomes of pts with shorter TLT, particularly those with primary refractory DLBCL (TLT <6 mo). Novel therapeutic approaches are needed for this high-risk patient population, and future studies of 2L therapy should stratify enrollment by TLT to control for this source of confounding.
Keyword(s): High-grade non-Hodgkins-lymphoma, Outcome measurement, Refractory, Survival
Abstract: EP519
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Primary refractory disease is a major challenge in patients (pts) with diffuse large B-cell lymphoma (DLBCL), and is commonly defined as disease progression during first-line (1L) therapy or within 6 months (mo) of completing 1L therapy. Poor outcomes in pts with primary refractory DLBCL were reported in SCHOLAR-1, a study based on data primarily from academic centers (Crump, et al. Blood 2017). A limited number of studies have evaluated real-world outcomes of pts with primary refractory DLBCL in the broader healthcare setting. Here, we report the results of real-world data (RWD) analyses from two US sources.
Aims
To describe outcomes of pts with DLBCL receiving second-line (2L) therapy from RWD according to the time from last treatment (TLT), defined by the time from end of 1L to the start of 2L therapy.
Methods
This study used the nationwide Flatiron Health (FH) electronic health record-derived de-identified database and the Surveillance, Epidemiology, and End Results (SEER)-Medicare (SEER-M)-linked database, which combines the SEER Cancer Registry and Medicare claims database. The majority of pts in the FH database originate from community oncology settings; relative community/academic proportions may vary depending on study cohort. The data of pts with DLBCL who received 2L therapy between Jan 2011–Jan 2020 in FH and Jan 2011–Dec 2015 in SEER-M were reviewed. Pts aged ≥18 years (pts in SEER-M were aged >65 years) with DLBCL, who were treated with cyclophosphamide- and doxorubicin-containing regimens in the 1L setting, were included for analysis. For SEER-M, all pts enrolled in fee-for-service Medicare were required to have complete claims. Data of pts who developed a secondary malignancy were censored at the time of the malignancy, and medical review of treatment regimens was performed for the final cohorts. Pts were grouped into three categories of TLT (<6 mo, 6–12 mo and >12 mo), and the impact of TLT was analyzed for association with overall survival (OS), defined by the time from the start of salvage therapy to death.
Results
Overall, 866 pts were included (FH: n=442; SEER-M: n=424) for analysis. Pt characteristics were similar between the cohorts, except median age at diagnosis (FH: 65 years; SEER-M: 74 years). Pts were mostly white (FH: 72.9%; SEER-M: 91.5%), male (FH: 63.1%; SEER-M: 52.1%), with Stage III–IV disease (FH: 64.9%; SEER-M: 69.5%). The most common 2L regimens were: rituximab (R) + carboplatin + etoposide + ifosfamide (39.8% in FH and 7.5% in SEER-M), R + bendamustine (14.0% in FH and 29.2% in SEER-M), and R + gemcitabine + oxaliplatin (8.4% in FH and 12.5% in SEER-M). Using a TLT cut-off of <6 mo, 236 (53.4%) pts in the FH cohort and 197 (45.3%) pts in the SEER-M cohort were classified as primary refractory. In the FH cohort, median OS for TLT <6 mo, 6–12 mo, and >12 mo were 9.1 mo (95% confidence interval [CI]: 8.1–13.1 mo), 20.9 mo (95% CI: 13.7–47.5), and 42.9 mo (95% CI: 22.8–57.3), respectively (Figure). In the SEER-M cohort, median OS for TLT <6 mo, 6–12 mo, and >12 mo were 8.6 mo (95% CI: 6.7–11.4), 11.7 mo (95% CI: 8.8–16 .1), and 18.9 mo (95% CI: 15.7–32.9), respectively.
Conclusion
Our RWD analysis highlights the poor outcomes of pts with shorter TLT, particularly those with primary refractory DLBCL (TLT <6 mo). Novel therapeutic approaches are needed for this high-risk patient population, and future studies of 2L therapy should stratify enrollment by TLT to control for this source of confounding.
Keyword(s): High-grade non-Hodgkins-lymphoma, Outcome measurement, Refractory, Survival