Adam J Olszewski1, Jaleh Fallah2, Jorge J Castillo3,4. 1. Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island. 2. Department of Medicine, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island. 3. Department of Medicine, Harvard Medical School, Boston, Massachusetts. 4. Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Abstract
BACKGROUND: Antiviral therapy has altered the prognosis of patients with human immunodeficiency virus (HIV)-associated non-Hodgkin lymphoma (NHL), but patterns of lymphoma-directed therapy in the community are unknown. METHODS: The authors analyzed the National Cancer Data Base records of 10,769 patients who were diagnosed with HIV-associated lymphoma from 2004 through 2012. Changes in clinical characteristics and chemotherapy delivery over time were evaluated. Factors that were associated with not receiving chemotherapy were studied using multivariable logistic regression, reporting odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The proportion of black or Hispanic patients with HIV-associated NHL increased from 41% in 2004 to 55% in 2012 (P < .0001). Chemotherapy was received by 81% of patients with diffuse large B-cell lymphoma, 90% of those with Burkitt lymphoma, 61% of those with primary effusion lymphoma (PEL), and 35% of those with primary central nervous system lymphomas (PCNSL). Between 2004 and 2012, this proportion increased only for patients with PCNSL (P < .00001). Chemotherapy was less likely to be received by patients who were older, black, or without private insurance. It was delivered more frequently in hospitals designated as academic (OR for nonreceipt, 0.68; 95% CI, 0.51-0.92) or in hospitals that had ≥3 HIV-positive cases per year (OR, 0.71; 95% CI, 0.58-0.86). Survival improved in patients with diffuse large B-cell lymphoma (P = .007), Burkitt lymphoma (P = .0002), and PCNSL (P = .019), but not in those with PEL (P = .94). Receipt of chemotherapy in patients with PEL was not associated with better survival. CONCLUSIONS: Disparities in chemotherapy delivery need attention, because a majority of HIV-positive patients with NHL in the United States are now black or Hispanic. Higher volume centers were associated with an increased likelihood of chemotherapy administration. Survival gains in patients with PCNSL parallel an increase in chemotherapy use, supporting its role in therapy. [See Editorial on pages 000-000, this issue.] Cancer 2016.
BACKGROUND: Antiviral therapy has altered the prognosis of patients with human immunodeficiency virus (HIV)-associated non-Hodgkin lymphoma (NHL), but patterns of lymphoma-directed therapy in the community are unknown. METHODS: The authors analyzed the National Cancer Data Base records of 10,769 patients who were diagnosed with HIV-associated lymphoma from 2004 through 2012. Changes in clinical characteristics and chemotherapy delivery over time were evaluated. Factors that were associated with not receiving chemotherapy were studied using multivariable logistic regression, reporting odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The proportion of black or Hispanic patients with HIV-associated NHL increased from 41% in 2004 to 55% in 2012 (P < .0001). Chemotherapy was received by 81% of patients with diffuse large B-cell lymphoma, 90% of those with Burkitt lymphoma, 61% of those with primary effusion lymphoma (PEL), and 35% of those with primary central nervous system lymphomas (PCNSL). Between 2004 and 2012, this proportion increased only for patients with PCNSL (P < .00001). Chemotherapy was less likely to be received by patients who were older, black, or without private insurance. It was delivered more frequently in hospitals designated as academic (OR for nonreceipt, 0.68; 95% CI, 0.51-0.92) or in hospitals that had ≥3 HIV-positive cases per year (OR, 0.71; 95% CI, 0.58-0.86). Survival improved in patients with diffuse large B-cell lymphoma (P = .007), Burkitt lymphoma (P = .0002), and PCNSL (P = .019), but not in those with PEL (P = .94). Receipt of chemotherapy in patients with PEL was not associated with better survival. CONCLUSIONS: Disparities in chemotherapy delivery need attention, because a majority of HIV-positivepatients with NHL in the United States are now black or Hispanic. Higher volume centers were associated with an increased likelihood of chemotherapy administration. Survival gains in patients with PCNSL parallel an increase in chemotherapy use, supporting its role in therapy. [See Editorial on pages 000-000, this issue.] Cancer 2016.
Keywords:
National Cancer Data Base; acquired immunodeficiency syndrome (AIDS); epidemiology; human immunodeficiency virus; non-Hodgkin lymphoma; outcomes research
Authors: Paul G Rubinstein; Page C Moore; Michelle A Rudek; David H Henry; Juan C Ramos; Lee Ratner; Erin Reid; Elad Sharon; Ariela Noy Journal: AIDS Date: 2018-03-13 Impact factor: 4.177
Authors: Juan Pablo Alderuccio; Adam J Olszewski; Andrew M Evens; Graham P Collins; Alexey V Danilov; Mark Bower; Deepa Jagadeesh; Catherine Zhu; Amy Sperling; Seo-Hyun Kim; Ryan Vaca; Catherine Wei; Suchitra Sundaram; Nishitha Reddy; Alessia Dalla Pria; Christopher D'Angelo; Umar Farooq; David A Bond; Stephanie Berg; Michael C Churnetski; Amandeep Godara; Nadia Khan; Yun Kyong Choi; Shireen Kassam; Maryam Yazdy; Emma Rabinovich; Frank A Post; Gaurav Varma; Reem Karmali; Madelyn Burkart; Peter Martin; Albert Ren; Ayushi Chauhan; Catherine Diefenbach; Allandria Straker-Edwards; Andreas Klein; Kristie A Blum; Kirsten Marie Boughan; Agrima Mian; Bradley M Haverkos; Victor M Orellana-Noia; Vaishalee P Kenkre; Adam Zayac; Seth M Maliske; Narendranath Epperla; Paolo Caimi; Scott E Smith; Manali Kamdar; Parameswaran Venugopal; Tatyana A Feldman; Daniel Rector; Stephen D Smith; Andrzej Stadnik; Craig A Portell; Yong Lin; Seema Naik; Silvia Montoto; Izidore S Lossos; Kate Cwynarski Journal: Blood Adv Date: 2021-07-27