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[Blood Adv] Analysis of causes of death in low-grade B-cell lymphoma in the rituximab era - from a prospective cohort study

 Last Update: 2022-08-15
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Analysis of Causes of Death

low-grade B-cell lymphoma

Indolent B-cell lymphomas are a group of neoplastic diseases that account for approximately 35-45% of non-Hodgkin lymphomas (NHLs) in the We.

Despite advances in treatment, lymphoma remains the leading cause of death (COD) in FL patien.

Studies have found that if patients with non-FL low-grade B-cell lymphomas (LGBCL) do not have disease progression, relapse, or need for retreatment within 12 months of diagnosis, survival is similar to that of the general population, whereas Early disease progression or retreatment was associated with poorer survival after progression; similar results were observed in the MZL patient cohort in the FIL-NF10 study and in MALT lymphoma patients in the IELSG-19 stu.

Based on this, Professor Matthew.

Key points of this article

Mortality in patients with marginal zone lymphoma and indolent B-cell lymphoma is largely unrelated to lymphoma in the first decade after diagnosis

Early progression or retreatment within 24 months of diagnosis is strongly associated with an increased risk of lymphoma-related death

Research design

MER is a prospective cohort study of lymphoma outcomes established in 2002, including adult patients (≥18 years) with newly diagnosed lymphoma (within 9 months of diagnosis) in the United States, and enrolled patients newly diagnosed between 2002 and 201

The following histopathological diagnoses were analyzed in this study: 1) NMZL; 2) EMZL; 3) SMZL; 4) LPL/WM; 5) Unclassified low-grade B-cell lymphoma (LGBCL-U), LGBCL mentioned below All five categories (excluding follicular lymphoma); patients with transformation at diagnosis and/or concomitant DLBCL or other aggressive B-cell lymphoma were exclud.

Authors verified disease progression, retreatment, transformation, and death by medical record review, death certificates and/or medical records were reviewed by MER physicians using standard protocols, and cause of death was classified as lymphoma (progression or transformation), treatment, unrelated tumor, other Reason or unkno.

Research result

Patient baseline characteristics and initial treatment strategy

A total of 822 newly diagnosed LGBCL patients enrolled in MER from 2002 to 2015 were included in this stu.

The first-line treatment strategies for LGBCL patients are shown in Table 1, and there are differences between different subtyp.

During a median follow-up of 9 years, 31 (8%) had transformation and 219 (27%) di.

Cumulative incidence and distribution of overall/subtype causes of death

The 10-year all-cause OS for the cohort was 78% (F.

The 10-year estimate of lymphoma-related mortality in the overall population was 0%, which was lower than non-lymphoma-related mortality (16%) (Figure 2.

The 10-year estimate of lymphoma-related mortality in the overall population was 0%, which was lower than non-lymphoma-related mortality (16%) (Figure 2.

Causes of death by subtype are shown in Figure 2 (B.

The lowest mortality rate was in EMZL (10-year estimate 7.

The highest incidence of non-lymphoma-related death was SMZL (10-year estimate 20%), followed by LGBCL-U (10-year estimate 15%); LPL/WM had the lowest rate (10-year estimate 9.

Patterns of causes of death by key demographic and clinical characteristics are shown in Table

The incidence of both lymphoma-related and non-lymphoma-related deaths increased with age at diagnos.

The 10-year estimates for lymphoma-related death were 1% vs 0% vs 18% in patients diagnosed at age ≤60 years vs 61-70 years vs >70 years, respectively (p<001), while non-lymphoma-related deaths The 10-year estimates of mortality were 0% vs 17% vs 25%, respectively (p < 001) (Figure 3 A.

Notably, the cumulative incidence of non-lymphoma-related deaths was higher than that of lymphoma-related deaths in all age grou.

In addition, lymphoma-related deaths (10-year estimate for men 7% .

4% for women, p=12) or non-lymphoma-related deaths (10-year estimate for men 16% .

17% for women, p=06) differed by gend.

) were not clinically significantly different, and the pattern of causes of death was similar between the subgroups of patients diagnosed in 2002-2008 and those diagnosed in 2009-201

Adverse clinical features are broadly associated with increased lymphoma-related deat.

Lymphoma-related mortality was significantly higher in patients with elevated lactate dehydrogenase (LDH) at diagnosis (10-year estimate 18%) than in patients without elevated LDH (5%, p=001), non-lymphoma-related deaths The rate was the same (14% vs 14% at 10 years, p=9
Lymphoma-related deaths (10-year estimate 16%) and non-lymphoma-related deaths (10-year estimate 19%) were higher in patients with hemoglobin (HGB) < 12 g/dL than those with HGB ≥ 12 g/dL (10-year estimates were 5%, p=001 and 15%, p=00
Similarly, lymphoma-related deaths in patients with stage III–IV disease (10-year estimate 14%, p<001) compared with patients with stage I/II disease (10-year estimate 2% vs 4%, p=013) There was also a higher incidence of non-lymphoma-related death (10-year estimate 11%, p=01

Patterns of causes of death by baseline prognostic index

Higher follicular lymphoma International Prognostic Index (FLIPI) scores (scores 0-1 vs 2 vs 3-5) were associated with higher cumulative incidence of both lymphoma-related and non-lymphoma-related deaths, and 10-year lymphoma-related Mortality rates were 3% vs 8% vs 18%, and 10-year non-lymphoma-related mortality rates were 5% vs 15% vs 23%, respectively, all p < 0001 (Table 2 and Figure

The pattern of cumulative increase in the MALT-IPI score in lymphoma and non-lymphoma-related mortality was also similar with increasing score, but the cumulative incidence was differe.

The 10-year cumulative incidence of lymphoma-related death was 3% vs 4% vs 18% for patients with MALT-IPI 0 vs 1 vs 2-3 scores (p < 001), and the 10-year cumulative incidence of non-lymphoma-related death was 3% vs 10% vs 10% (p < 001; Table
A similar pattern existed for IPI scores (Table
Notably, the cumulative incidence of non-lymphoma-related deaths was higher than that of lymphoma-related deaths in all IPI, FLIPI, and MALT-IPI grou.

Patterns of causes of death by clinical outcome

The authors assessed patterns of cause of death based on transformation and EFS24 stat.

Among patients with transformed disease, lymphoma-related mortality was higher than non-lymphoma-related mortali.

Among the 31 patients who developed transformation during follow-up, the 5-year estimate for lymphoma-related deaths after the date of transformation was 34%, compared with 5% for non-lymphoma-related deaths 5 years after transformati.

The 621 patients who achieved EFS24 (calculated from reaching EFS24) had a very low lymphoma-related mortality rate of 1% at 10 years (Figure 5A); Lymphoma-related mortality was 11% 10 years after the early event (p < 001; Table 2, Figure 5.

There was no significant difference in non-lymphoma-related mortality between patients who did not achieve EFS24 and those who did (10% vs 13% at 10 years, p = 3
Also of note, among patients who did not reach EFS24, lymphoma-related mortality was higher than non-lymphoma-related mortality (11% vs 10% at 10 years) (Figure

in conclusion

This study is the largest unclassifiable cause of death among patients with unclassifiable marginal zone lymphoma, lymphoplasmacytic lymphoma, and low-grade malignant B-cell lymphoma with complete clinical characteristics, treatment, and outcome data in the era of rituxim.

A large-scale prospective cohort study is helpful for patient consultation and prognos.

Overall, the most common cause of death in low-grade B-cell lymphoma at 10 years was not related to lymphoma, in contrast to previous data on FL and CLL/SLL, which reported that lymphoma was the most common at 10 years cause of dea.

As with FL, however, patients with low-grade B-cell lymphoma who failed to achieve EFS24 had a significantly increased risk of lymphoma-related dea.

The authors argue that more efforts are needed to address other causes of death, while developing new treatment strategies and clinical and biological markers to predict early progressi.

references

Aung Tun ,et .

Causes of Death in Low Grade B-Cell Lymphomas in the Rituximab Era: A Prospective Cohort Stu.

Blood Ad.

2022 Jul 18;bloodadvanc.

202200799 doi: 11182/bloodadvanc.

202200799

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