Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina.
Department of Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina.
Cancer. 2021 Nov 1;127(21):3991-3997. doi: 10.1002/cncr.33779. Epub 2021 Jul 21.
Aggressive large B-cell lymphomas (LBCLs) are curable, but previous studies have shown inferior outcomes in minorities. Nurse navigation programs can improve patient outcomes by providing patient support. This study presents the outcomes of White and minority patients with aggressive LBCL at an institution with an active nurse navigation program.
The authors prospectively collected baseline characteristics, treatment regimens, and outcome data for patients with aggressive LBCL. Navigation encounters were characterized as low or high intensity. Overall survival (OS) and progression-free survival (PFS) were calculated with Kaplan-Meier methods. Baseline characteristics were compared with Fisher exact tests.
Two hundred four consecutive patients (47 minority patients and 157 White patients) were included. Results were presented as minorities versus Whites. There were no differences in prognostic scores (Revised International Prognostic Index score of 3-5, 43% vs 47%; P = .50), frontline chemotherapy (98% vs 96%; P = .68), or the incidence of relapsed/refractory disease (40% vs 38%; P = .74). For relapsed/refractory LBCL, similar proportions of patients underwent hematopoietic stem cell transplantation (32% vs 29%; P > .99) or chimeric antigen receptor T-cell therapy (16% vs 19%; P > .99). Enrollment in clinical trials was comparable (17% vs 14%; P = .64). More than 85% received nurse navigation, but minorities had higher intensity navigation encounters (42% vs 21%; P = .01). The 2-year OS rates were 81% and 76% for minorities and Whites, respectively (P = .27); the 2-year PFS rates were 62% and 65%, respectively (P = .78).
This study shows similar survival between Whites and minorities with aggressive LBCL, which was likely due to equal access to guideline-concordant therapy. Minorities received higher intensity navigation encounters, which may have helped them to overcome socioeconomic disadvantages.
侵袭性大 B 细胞淋巴瘤（LBCL）是可治愈的，但先前的研究表明少数族裔患者的预后较差。护士导航计划通过为患者提供支持可以改善患者的预后。本研究报告了在一家有积极护士导航计划的机构中，患有侵袭性 LBCL 的白人和少数族裔患者的结果。
作者前瞻性地收集了侵袭性 LBCL 患者的基线特征、治疗方案和结局数据。将导航接触描述为低强度或高强度。采用 Kaplan-Meier 方法计算总生存期（OS）和无进展生存期（PFS）。采用 Fisher 精确检验比较基线特征。
204 例连续患者（47 例少数族裔患者和 157 例白人患者）被纳入研究。结果以少数族裔与白人进行比较。两组患者的预后评分（修订后的国际预后指数评分 3-5 分，43%比 47%；P=0.50）、一线化疗（98%比 96%；P=0.68）或复发/难治性疾病的发生率（40%比 38%；P=0.74）均无差异。对于复发/难治性 LBCL，接受造血干细胞移植（32%比 29%；P＞0.99）或嵌合抗原受体 T 细胞治疗（16%比 19%；P＞0.99）的患者比例相似。临床试验的入组比例相当（17%比 14%；P=0.64）。超过 85%的患者接受了护士导航，但少数族裔患者的导航接触强度更高（42%比 21%；P=0.01）。两组患者的 2 年 OS 率分别为 81%和 76%（P=0.27）；2 年 PFS 率分别为 62%和 65%（P=0.78）。
本研究显示，侵袭性 LBCL 患者的白人和少数族裔之间的生存率相似，这可能是由于他们能够平等地获得符合指南的治疗。少数族裔患者接受了更高强度的导航接触，这可能帮助他们克服了社会经济劣势。
