Survival after diffuse large B-cell lymphoma among children, adolescents, and young adults in California, 2001–2014: A population-based study

R. Abrahão, R. C. Ribeiro, D. Y. Lichtensztajn, A. S. Rosenberg, Theresa H Keegan

Research output: Contribution to journalArticle

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Abstract

Background: This population-based study considered the influence of rituximab on the survival of children (0–19 years), adolescents, and young adults (AYAs, 20–39 years) with diffuse large B-cell lymphoma (DLBCL), including patients with human immunodeficiency virus (HIV) infection. Methods: Data on 642 children and AYAs diagnosed with DLBCL during 2001–2014 were obtained from the Greater Bay Area Cancer Registry in California. Facility-level reports provided treatment details. The Kaplan–Meier method estimated survival and Cox regression models examined the association between survival and rituximab use, adjusting for sociodemographic and clinical factors. Results: Rituximab use increased from 2001–2007 to 2008–2014 among children (from 32% to 48%), AYAs (from 68% to 84%), and HIV patients (from 57% to 67%). Five-year survival was higher among children (91%) than AYAs (82%). On multivariable analysis, the hazard of death was 44% lower among rituximab recipients, and higher among uninsured patients, those with HIV, and those with advanced stage at diagnosis. HIV patients who received rituximab were 60% less likely to die than nonrecipients. Conclusions: Our study suggests a benefit of rituximab on the treatment of AYAs and HIV patients with DLBCL. The worse survival observed among HIV-positive and uninsured patients is of concern and calls for further investigation. Careful consideration should be given on whether to recommend rituximab more often on the front-line treatment of children and HIV-positive patients with DLBCL.

Original languageEnglish (US)
Article numbere27559
JournalPediatric Blood and Cancer
DOIs
StateAccepted/In press - Jan 1 2018

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Lymphoma, Large B-Cell, Diffuse
Young Adult
HIV
Survival
Population
Virus Diseases
Rituximab
Proportional Hazards Models
Registries
Therapeutics
Neoplasms

Keywords

  • AYA
  • children
  • DLBCL
  • population-based study
  • rituximab
  • survival

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

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Survival after diffuse large B-cell lymphoma among children, adolescents, and young adults in California, 2001–2014 : A population-based study. / Abrahão, R.; Ribeiro, R. C.; Lichtensztajn, D. Y.; Rosenberg, A. S.; Keegan, Theresa H.

In: Pediatric Blood and Cancer, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: This population-based study considered the influence of rituximab on the survival of children (0–19 years), adolescents, and young adults (AYAs, 20–39 years) with diffuse large B-cell lymphoma (DLBCL), including patients with human immunodeficiency virus (HIV) infection. Methods: Data on 642 children and AYAs diagnosed with DLBCL during 2001–2014 were obtained from the Greater Bay Area Cancer Registry in California. Facility-level reports provided treatment details. The Kaplan–Meier method estimated survival and Cox regression models examined the association between survival and rituximab use, adjusting for sociodemographic and clinical factors. Results: Rituximab use increased from 2001–2007 to 2008–2014 among children (from 32{\%} to 48{\%}), AYAs (from 68{\%} to 84{\%}), and HIV patients (from 57{\%} to 67{\%}). Five-year survival was higher among children (91{\%}) than AYAs (82{\%}). On multivariable analysis, the hazard of death was 44{\%} lower among rituximab recipients, and higher among uninsured patients, those with HIV, and those with advanced stage at diagnosis. HIV patients who received rituximab were 60{\%} less likely to die than nonrecipients. Conclusions: Our study suggests a benefit of rituximab on the treatment of AYAs and HIV patients with DLBCL. The worse survival observed among HIV-positive and uninsured patients is of concern and calls for further investigation. Careful consideration should be given on whether to recommend rituximab more often on the front-line treatment of children and HIV-positive patients with DLBCL.",
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AU - Rosenberg, A. S.

AU - Keegan, Theresa H

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AB - Background: This population-based study considered the influence of rituximab on the survival of children (0–19 years), adolescents, and young adults (AYAs, 20–39 years) with diffuse large B-cell lymphoma (DLBCL), including patients with human immunodeficiency virus (HIV) infection. Methods: Data on 642 children and AYAs diagnosed with DLBCL during 2001–2014 were obtained from the Greater Bay Area Cancer Registry in California. Facility-level reports provided treatment details. The Kaplan–Meier method estimated survival and Cox regression models examined the association between survival and rituximab use, adjusting for sociodemographic and clinical factors. Results: Rituximab use increased from 2001–2007 to 2008–2014 among children (from 32% to 48%), AYAs (from 68% to 84%), and HIV patients (from 57% to 67%). Five-year survival was higher among children (91%) than AYAs (82%). On multivariable analysis, the hazard of death was 44% lower among rituximab recipients, and higher among uninsured patients, those with HIV, and those with advanced stage at diagnosis. HIV patients who received rituximab were 60% less likely to die than nonrecipients. Conclusions: Our study suggests a benefit of rituximab on the treatment of AYAs and HIV patients with DLBCL. The worse survival observed among HIV-positive and uninsured patients is of concern and calls for further investigation. Careful consideration should be given on whether to recommend rituximab more often on the front-line treatment of children and HIV-positive patients with DLBCL.

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