302 | PREDICTING OUTCOMES IN DIFFUSE LARGE B‐CELL LYMPHOMA PATIENTS ELIGIBLE FOR FRONT‐LINE TRIALS USING HARKINS' ENHANCED ELIGIBILITY CRITERIA
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Bataillard et al. 2021) is critical for cure, but its interplay with SES and illness burden remains unexplored at the patient level.Methods: We conducted a single-center retrospective study of patients treated for DLBCL (2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024) at Columbia University (New York).Neighborhood poverty rate and area deprivation indices (ADI, national percentile) were defined using ZIP codes and U.S. 2022 Census data.In patients receiving > 1 cycle, relative dose intensity (RDI) was calculated as total delivered dose/usual dose (300 or 4500 mg/m 2 for doxorubicin [doxo] or cyclophosphamide [cyclo]) � 18 weeks/actual duration.RDI of doxo and cyclo were averaged (ARDI).The primary endpoint was progression-free survival (PFS).Results: A total 344 patients were included (Table); median age was 69 (IQR 57-77), 74% had stage III/IV, 66% had an international prognostic index (IPI) 3-5, 40% ECOG PS > 1 and 34% bulky disease.Median ADI was 16 (IQR 7-27), 59% lived in a neighborhood with high poverty rate (> U.S. 2022 rate 11.5%), 45% were Hispanic, 40% non-Hispanic White and 11% non-Hispanic Black; 32% had commercial insurance, 20% Medicaid and 49% Medicare.Median Charlson Comorbidity Index (CCI) was 6 (IQR 4-7) and 41% were diagnosed and started treatment inpatient.Median RDI was 0.83 (IQR 0.61-0.93)for doxo and 0.89 (IQR 0.69-1) for cyclo (n = 298 evaluable).With a median follow-up of 3.4 years, 4-year PFS and overall survival (OS) were 51% and 65%.High neighborhood poverty (vs low) was associated with PFS (HR 1.32, p = 0.095) and higher likelihood of inpatient diagnosis/treatment (49% vs. 30%, p < 0.001).A multivariable Cox regression adjusted for poverty, IPI factors, sex, double expressor lymphoma (DEL), bulky disease, CCI, inpatient status and ARDI found that DEL (HR 1.95 p = 0.001), ECOG PS > 1 (HR 2.18 p = 0.002) and each 0.1 decrease in ARDI (HR 1.21 p < 0.001) were significant for PFS; DEL (HR 2.00 p = 0.008), ECOG PS > 1 (HR 3.86 p < 0.001), CCI (HR 1.22 p < 0.001) and each 0.1 decrease in ARDI (HR 1.28 p < 0.001) were significant for OS.A ROC curve set ARDI ≥ 0.9 for stratifying PFS.Race/ethnicity, insurance, ADI and poverty did not differ between ARDI ≥ 0.9 versus < 0.9, but low ARDI was associated with high IPI, ECOG PS > 1, pre-phase therapy, inpatient diagnosis/treatment and CCI (p < 0.001).After adjusting for baseline variables, patients with high poverty/high ARDI had worse PFS (HR 1.78, Figure ) and OS (HR 3.55) versus low poverty/high ARDI.Conclusions: In this diverse cohort of newly diagnosed DLBCL treated at an urban academic cancer center, neighborhood poverty was linked to high acuity requiring inpatient care.Biologic features, functional status/comorbidities and chemotherapy dose intensity influenced survival, stressing the importance of comprehensive cancer-directed and supportive care.
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DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- 302 | PREDICTING OUTCOMES IN DIFFUSE LARGE B‐CELL LYMPHOMA PATIENTS ELIGIBLE FOR FRONT‐LINE TRIALS USING HARKINS' ENHANCED ELIGIBILITY CRITERIA
- Date Crossref
- 01/06/2025
- Éditeur
- Wiley
- Type
- journal-article
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Odense University Hospital pays non établi dans la noticeOrganisme public
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University of Belgrade pays non établi dans la noticeUniversité ou école supérieure
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Aalborg University Hospital pays non établi dans la noticeÉtablissement de santé
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Aalborg University pays non établi dans la noticeUniversité ou école supérieure
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Odense University Hospital, University of Belgrade et Aalborg University Hospital, avec 9 autres affiliations.
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