Jiang Jun Y, Nze Chijioke, Guffey Danielle, Kim Rockbum, Oluyomi Abiodun O, Rosales Omar, Bandyo Raka, Miller-Chism Courtney N, Udden Mark M, Mims Martha P, Ma Hilary, Rivero Gustavo A, Diamond Akiva, Teegavarapu Purnima S, Li Ang, Flowers Christopher R
Department of Medicine, Section of Hematology & Oncology, Baylor College of Medicine, Houston, TX.
Department of Lymphoma & Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
Blood Neoplasia. 2024 May 20;1(3):100020. doi: 10.1016/j.bneo.2024.100020. eCollection 2024 Sep.
Real-world outcome data for patients with large B-cell lymphomas (LBCLs) who are uninsured or have socioeconomic barriers to care are limited. We performed a retrospective cohort study of patients with newly diagnosed LBCL treated in a large safety-net hospital system. Between January 2011 and June 2022, 496 patients aged >18 years were diagnosed with LBCL at Harris Health System, Houston, Texas. The median age was 53 years, 75% were uninsured, and 81% were in the most disadvantaged Area Deprivation Index national quartiles. Most (69%) had stage III/IV disease, 44% had poor-risk disease by the Revised International Prognostic Index (R-IPI), and 17% had a history of HIV infection. The median diagnosis-to-treatment interval was 17 days. The median follow-up time was 53.5 months. Among 464 evaluable patients, 66% achieved a complete response, and 11% had a partial response. Of 48 patients, 26 (54%) eligible for cell therapies received them. At 5 years, event-free and overall survival (OS) rates were 57% and 68%, respectively. Factors that affected OS included Hispanic ethnicity (hazard ratio [HR], 0.70; = .027), R-IPI (HR, 4.67 for poor vs very good risk; < .001), National Cancer Institute Comorbidity Index (HR, 1.53 per unit increment; = .003), hemoglobin (HR, 0.89 per unit increment; = .002), and International Normalized Ratio (HR, 2.17 per unit increment; = .007). Insurance status was not associated with differences in OS. In our safety-net health system with robust financial assistance programs and limited access to cell therapies, uninsured status was not associated with inferior outcomes. Addressing barriers to care may improve outcomes in other settings.
针对未参保或存在社会经济护理障碍的大B细胞淋巴瘤（LBCL）患者，真实世界的结局数据有限。我们对在一个大型安全网医院系统接受治疗的新诊断LBCL患者进行了一项回顾性队列研究。2011年1月至2022年6月期间，德克萨斯州休斯顿哈里斯健康系统诊断出496名年龄大于18岁的LBCL患者。中位年龄为53岁，75%未参保，81%处于全国最贫困地区贫困指数四分位数。大多数（69%）为III/IV期疾病，44%根据修订后的国际预后指数（R-IPI）为高危疾病，17%有HIV感染史。中位诊断至治疗间隔为17天。中位随访时间为53.5个月。在464名可评估患者中，66%达到完全缓解，11%有部分缓解。在48名患者中，26名（54%）符合细胞治疗条件并接受了治疗。5年时，无事件生存率和总生存率（OS）分别为57%和68%。影响OS的因素包括西班牙裔种族（风险比[HR]，0.70；P = .027）、R-IPI（高危与极低危相比HR为4.67；P < .001）、美国国立癌症研究所合并症指数（HR，每增加一个单位为1.53；P = .003）、血红蛋白（HR，每增加一个单位为0.89；P = .002）和国际标准化比值（HR，每增加一个单位为2.17；P = .007）。保险状况与OS差异无关。在我们拥有强大财务援助计划且细胞治疗获取有限的安全网医疗系统中，未参保状态与较差结局无关。消除护理障碍可能会改善其他环境中的结局。
