non-Hodgkin Lymphoma Survivors Research Articles

Economic burden in non-Hodgkin lymphoma survivors: The French Lymphoma Study Association SIMONAL cross-sectional study.

No study has focused on the economic burden in non-Hodgkin lymphoma (NHL) survivors, even though this knowledge is essential. This study reports on health care resource use and associated health care costs as well as related factors in a series of 1671 French long-term NHL survivors. Health care costs were measured from the payer perspective. Only direct medical costs (medical consultations, outpatient treatments, hospitalizations, and medical transport) in the past 12 months were included (reference year 2015). Multiple linear regression was used to search for explanatory factors of health care costs. In total, 1100 survivors (66%) reported having used at least 1 health care resource, and 867 (52%) reported having used at least 1 outpatient treatment. After the authors accounted for missing data, the mean health care cost was estimated at €702 ± €2221. Hospitalizations and outpatient treatments were the main cost drivers. Sensitivity analyses confirmed the robustness of the results. For the 1100 survivors who reported using at least 1 health care resource, the mean health care cost was €1067 ± €2268. Several factors demonstrated statistically significant relationships with health care costs. For instance, cardiovascular disorders increased costs by 66% ± 16%. In contrast, rituximab or autologous stem cell transplantation as initial therapy had no effect on health care costs. The consideration of economic constraints in health care is now a reality. This retrospective study reports on a better understanding of health care resource use and associated health care costs as well as related factors. It may help health care professionals in their ongoing efforts to design person-centered health care pathways.

Hospital, outpatient visits main drivers of costs for non-Hodgkin's lymphoma survivors in France

Hospital, outpatient visits main drivers of costs for non-Hodgkin's lymphoma survivors in France

Autonomic Imbalance in Lymphoma Survivors.

Among the types of blood cancers, non-Hodgkin lymphoma is the most common. The usual treatments for this type of cancer can cause heart failure. A descriptive observational study was conducted that included 16 non-Hodgkin lymphoma survivors and 16 healthy controls matched by age and sex. Vagal tone was evaluated in the short term with a three-channel Holter device, and the time and frequency domains were analyzed following a previously accepted methodology to evaluate cardiac autonomic balance. The results of the analysis revealed that the standard deviation of the NN interval (F = 6.25, p = 0.021) and the square root of the mean of the sum of the differences between NN intervals (F = 9.74, p = 0.004) were significantly higher in healthy subjects than in lymphoma survivors. In the heart rate variability (HRV) index, there were no significant differences between the groups (F = 0.03, p = 0.85), nor in the parameters of the frequency domains LF (F = 1.94, p = 0.17), HF (F = 0.35, p = 0.55), and the ratio LF/HF (F = 3.07, p = 0.09). HRV values were lower in non-Hodgkin lymphoma survivors in the first year after treatment, resulting in autonomic imbalance compared to healthy paired subjects.

Cardiovascular magnetic resonance for early detection of late cardiotoxicity in asymptomatic survivors of hodgkin and non-hodgkin lymphoma

Abstract Funding Acknowledgements Type of funding sources: None. Background Long-term survivors of Hodgkin (HL) and non-Hodgkin (NHL) lymphomas experience late adverse effects of mediastinal radiotherapy and/or anthracycline containing chemotherapy, which lead to premature cardiovascular morbidity and mortality. It is unknown whether early stages of myocardial dysfunction and heart failure in these survivors can be detected by cardiovascular magnetic resonance imaging (CMR). Purpose To identify early sensitive markers for the detection of subclinical late cardiotoxicity using CMR in asymptomatic survivors of HL and (primary mediastinal large B-cell lymphoma) NHL. Methods For this prospective observational study, we included 80 HL or selected NHL survivors, who have been free of disease for ≥5 years and were treated with mediastinal radiotherapy (RT) with/without chemotherapy. Patients with known cardiac disease were excluded. Included patients were compared to 40 age- and sex matched healthy controls. CMR included 1) cine imaging for assessment of left ventricular (LV) and right ventricular (RV) dimensions, systolic function and strain; 2) 2-dimensional late gadolinium enhancement (LGE) imaging; 3) T2 mapping and 4) pre- and post-contrast T1 mapping (MOLLI) for assessment of native T1 values and extracellular volume (ECV). Results Of the 80 patients, 78 (98%) had a history of HL and 2 (2%) of NHL with a mean age of 47 ± 11 years (46% male). All patients were treated with mediastinal RT which was combined with anthracycline containing chemotherapy in 68 (85%) patients. The median interval between diagnosis and CMR was 20 [14 – 26] years. Differences in CMR characteristics between patients and healthy controls are shown in the table. LV end-systolic volume was statistically significantly higher, but LV ejection fraction and mass were significantly lower in patients compared to healthy controls. RV volumes were significantly lower in patients, but RV ejection fraction was preserved. Strain parameters of the LV, i.e. global longitudinal strain, global circumferential strain and global radial strain, were slightly but significantly reduced in patients. No significant differences were found in myocardial T2 times and ECV; however, native myocardial T1 time was significantly higher in patients compared to healthy controls. LGE was detected in 25% of the patients and in the majority of patients with LGE this was classified as hinge point fibrosis. Conclusion Asymptomatic survivors of HL and NHL are not exempt of late cardiotoxicity, which can be detected by subtle changes in LV myocardial function, strain and native T1 value with CMR. Furthermore, late gadolinium enhancement was present in 25% of the patients. Further longitudinal studies are needed to assess the implication of these changes in relation to clinical outcome.

Abstract 902: Contributions of cancer treatment, comorbidities and obesity to aging-related diseases risks in B-cell non-Hodgkin's lymphoma survivors

Abstract Introduction. Prior studies on risk factors for aging-related diseases among B-cell non-Hodgkin's lymphoma (B-NHL) survivors are limited. In order to improve timely management and prevention of early-onset aging-related diseases among B-NHL survivors, the contribution of specific risk factors such as cancer treatment, preexisting comorbidities, obesity, and smoking is important to understand. Therefore, the purpose of this study is to calculate population attributable fractions (PAF) of risk factors for aging-related disease risks among B-NHL survivors in Utah. Methods. B-NHL survivors were identified in the Utah Cancer Registry (n = 2,146). Population attributable fraction (PAF) was calculated as P x (multi-adjusted relative risk - 1)/multi-adjusted relative risk, where P is the proportion of B-NHL survivors who were exposed to a specific risk factor, to estimate the burden of these risk factors for aging-related diseases ≥5 years after cancer diagnosis. Aging-related disease outcomes included heart disease, congestive heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, chronic kidney disease, and acute renal failure. Results. More than half of B-NHL survivors were men (54.5%) and were diagnosed <65 years old (60.1%). The majority of participants were nonsmokers (88.7%) and had no family history of lymphoma (94.9%). Approximately 42.6% of B-NHL survivors were overweight and 21.5% were obese at baseline. Cancer treatment contributed to 11.3% of heart disease, 11.2% of COPD, and 14.1% of chronic kidney disease. Charlson Comorbidity Index (CCI) at baseline contributed to all six diseases with a range of 9.9% of heart disease to 26.5% of chronic kidney disease. The most common comorbidities at baseline included chronic pulmonary disease (32.6%), diabetes without complications (12.5%), and myocardial infarction (9.2%) among B-NHL patients upon cancer diagnosis. High BMI at baseline contributed to 18.4% of congestive heart failure, 7.9% of pneumonia, and 12.8% of acute renal failure, while smoking contributed to these diseases with a range of 0.3% of pneumonia to 6.4% of acute renal failure. Conclusion. Cancer treatment contributed more to risk of chronic diseases such as heart disease, COPD, and chronic kidney disease. In terms of more acute conditions, high BMI at baseline contributed more to congestive heart failure and pneumonia than cancer treatment. Smoking at baseline, however, was not a major risk factor of these aging-related diseases in this B-NHL survivor cohort. Overall, baseline comorbidities consistently demonstrated high attributable risks across all six diseases, suggesting a need for prevention and management of preexisting comorbidities before and after cancer diagnosis. Citation Format: Krista Ocier, Sarah Abdelaziz, Seungmin Kim, Kerry Rowe, John Snyder, Vikrant Deshmukh, Michael Newman, Alison Fraser, Ken Smith, Christina A. Porucznik, Kimberley Shoaf, Joseph B. Stanford, Catherine J. Lee, Mia Hashibe. Contributions of cancer treatment, comorbidities and obesity to aging-related diseases risks in B-cell non-Hodgkin's lymphoma survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 902.

Risk of Subsequent Malignant Neoplasms in Survivors of Adolescent and Young Adult (AYA) Lymphoma and Leukemia

▪Introduction: Cancer survivors, particularly those with hematologic cancers are at increased risk of subsequent malignant neoplasms (SMNs). For survivors of adolescent and young adult (AYA) hematologic cancers, there is a paucity of information on the magnitude and modifiers of SMN risk, as well as outcomes after onset of SMN.Methods: 1,315 2+y survivors of non-Hodgkin lymphoma (NHL: N=510), Hodgkin lymphoma (HL: N=614), and acute leukemia (Leuk: N=191; 49% ALL, 49% AML), diagnosed at age 15-39y between 1990 to 2012, and treated at Kaiser Permanent Southern California (KPSC) were included in this retrospective cohort study. KPSC is the largest integrated managed care organization in Southern California, with documented 5-year insurance retention rates for AYA cancer survivors approaching 80% (JAYAO 2013 2:59). A non-cancer comparison group (N=17,020) was constructed by selecting KPSC members without a history of cancer individually matched to cancer survivors (1:13) on age at diagnosis, sex, and calendar year. All study subjects were followed from index date until the diagnosis of a malignancy (ascertained using KPSC and California State Cancer Registries), end of 2014, or death, whichever came first. The following analyses were conducted for overall SMNs and solid vs. non-solid SMNs separately: 1) Multivariable Poisson regression adjusting for age, sex, and race/ethnicity to estimate incidence rate ratio (IRR) for SMN comparing cancer survivors to non-cancer comparisons; 2) Cumulative incidence curves of SMN within cancer survivors; 3) Five-year mortality following onset of SMN (survivors) or de novo malignancy (non-cancer comparison); 4) Within cancer survivors, multivariable Poisson regressions to examine the effect of age, sex, race/ethnicity, stage at diagnosis, and radiation exposure on risk of SMNs.Results: Among cancer survivors, median age at cancer diagnosis was 28y; 51.6% male; 46.2% non-Hispanic white. Median time from cancer diagnosis to end of follow-up was 8.9y (range: 0-23y), representing 11,675 person-years of follow-up. Of the 71 SMNs in cancer survivors, the most common diagnoses were NHL (23%) followed by breast cancer (14%); yet 72% of SMNs were solid tumor. Of the 297 de novo cancer in non-cancer comparisons, 93% were solid tumors. Incidence rate of SMN was 6.08 (7.43 in NHL, 5.66 in HL and 3.91 in Leuk survivors) per 1,000 person-years in cancer survivors. Comparison with non-cancer subjects, a significantly increased risk of SMNs was found in cancer survivors [overall IRR=3.4 (95% confidence interval, 2.6-4.4); NHL IRR=4.0 (2.7-5.9); HL IRR=3.1 (2.1-4.6); Leuk IRR=2.6 (1.1-6.2)]. The overall relative risk was higher for non-solid SMNs: IRR=13.3 (7.3-24.4) than for solid SMN (IRR=2.7 [2.0-3.7]). Cumulative incidence: there was a steep increase in SMN incidence at 18 years after initial cancer diagnosis in cancer survivors (Figure 1), primarily driven by solid tumors (Figure 2). Modifiers of SMN risk within cancer survivors: female sex (IRR=1.88 [1.03-3.43]) and radiation therapy (IRR=1.94 [1.06-3.53]) were associated with increased risk of solid SMNs; while Hispanic race/ethnicity (IRR=0.46 [0.22-0.98]) was associated with lower risk. Black race/ethnicity (IRR=5.30 [1.66-16.97]) was associated with increased risk of non-solid SMNs. Survivors of HL had a lower risk of non-solid SMNs (IRR=0.25 [0.07-0.92]) when compared to those with NHL (referent). Outcomes following malignancy: Five-year overall survival was significantly worse for cancer survivors with solid SMNs when compared to non-cancer subjects who developed a de novo solid tumor after the index date (65% vs. 86%, p=0.02); there was no difference in survival among those with non-solid SMNs (73% vs. 80%, p=1.00).Conclusion: Survivors of AYA hematologic malignancies are at increased risk of developing SMN when compared to matched non-cancer subjects. In these survivors, there is a steep increase in the incidence of solid tumors >15 years after completion cancer therapy, and certain patient as well as treatment (radiation exposure) characteristics are important modifiers of risk. Among AYA survivors, survival after solid SMN was significantly worse when compared to survival after de novo solid cancer. Taken together these data form the basis for identifying high-risk individuals for population-based targeted surveillance and early screening strategies. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The Widow Maker: A National Inpatient Sample Study of Health Care Utilization Costs for Cardiovascular Complications Patients Diagnosed with Non-Hodgkin's Lymphoma from 2000-2014

Background:Combination chemotherapy has improved the prognosis of DLBCL but has the potential for cardiovascular toxicity that can contribute to long-term morbidity and mortality. There is limited literature assessing the health care utilization costs for cardiovascular outcomes in patients diagnosed with non Hodgkin Lymphoma (NHL). We conducted this study to evaluate trends in hospital cost, length of stay, complication rates, and in-hospital mortality in adult patients diagnosed with non-Hodgkin lymphomas admitted for cardiovascular complications.Methods:We conducted a population-based study from the Nationwide Inpatient Sample (NIS). All adult admissions with a diagnosis of NHL from 2000-2014 were identified using ICD-9 codes. A priori outcome measures were left heart failure, atrial or ventricular arrhythmias, malignant or accelerated hypertension, hypertensive encephalopathy, and aortic dissection. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Logistic regression was used to compare rates of cardiovascular complications and mortality, cost, and length of stay between patients with NHL the general cardiovascular admissions (GCV), and between teaching and non-teaching hospitals.Results:Data were available for 9711761 hospitalized adults, of which 9711761 comprised the NHL group. The incidence of hospitalization for cardiovascular complications was 2.8 (OR = 2.78, 95% confidence interval [CI] 2.48+/-3.16) times higher in the NHL group than the general cardiovascular admissions (GCV) (58.7% versus 20.9%, P=0.005). Patients with Non Hodgkins lymphoma were 2.8 times more likely to be seen in the ED and admitted with cardiovascular complications than GCV patients (7,112,300 in the NHL group vs. 2,599,450 GCV group p< .005). Cardiovascular death was also twice as common in the NHL group (OR 2.2 95% confidence interval [CI] 1.9-3.6, 28.45% versus 19.54, P= 0.014). Risk factors for death included age ≥ 70 years (OR = 2.1, 95% confidence interval [CI] 1.4-3.0), male sex (OR=2.4, 95%CI 1.6-3.3) Caucasian race (OR=2.3, 95%CI 1.8-3.1), and admission at a teaching hospital (OR=1.67, 95%CI 1.2-2.4), average length of stay (4.8 days versus 2.3 days per 100 patients, p< 0.023) and total hospital cost ($960,554, 4206±45206 versus $479,167 ±19672, p = .002) were significantly higher in NHL patients than GCV patients. The leading cause of mortality was ventricular arrhythmias (88,350 death in the NHL group and 36,530 deaths in the GCV group). Rates for atrial arrhythmias, heart failure, acute myocardial infarction and accelerated hypertension were similar in both groups.Conclusions: There is a high rate of cardiovascular morbidity in NHL patients and survivors, which contributes hospitalization, cost, and increased morbidity and mortality. This large population based study identifies a need for cardiovascular screening and risk reduction strategies after treatment for NHL. DisclosuresNo relevant conflicts of interest to declare.

High Prevalence and Incidence of Fractures in Patients Treated for Aggressive B-Cell Non-Hodgkin Lymphomas

▪IntroductionPatients with non-Hodgkin lymphoma (NHL) are diagnosed at a median age of 67, with about 70% surviving over 5 years. The chemotherapy regimens for aggressive NHL includes cyclophosphamide and high doses of corticosteroids, which can result in significant bone loss. Previous studies have shown that fracture incidence approaches 30% by 10 years post-therapy and can impair quality of life of NHL survivors. However, there are no guidelines for bone health management in NHL patients, and additional screening for osteoporosis can be cumbersome and thus not routinely done. By reviewing standard of care pre- and post-treatment CT scans, we aim to evaluate the prevalence and incidence of fractures in patients treated for aggressive B-cell NHL.MethodsIn this retrospective single-center study, we reviewed patients seen at the University of California San Francisco lymphoma clinic in the last year who met the following criteria: 1) had aggressive B-cell NHL excluding primary central nervous system lymphoma, 2) received first-line therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or similar regimens such as with the addition of etoposide (R-EPOCH), 3) had baseline and post-treatment chest/abdomen/pelvis CT scans available for review. Baseline clinical characteristics and treatment information were collected from review of medical records. Axial CT images as well as sagittal and coronal reconstructions of chest/abdomen/pelvis CT images obtained at baseline and up to 2 years post-treatment were reviewed and graded by 2 radiologists to identify prevalent and incident fractures of the vertebrae, ribs, and pelvis. Exploratory analyses were performed using STATA, and comparisons between groups with or without fractures were performed with t-test or chi-squared test.ResultsWe identified 82 patients who met the inclusion criteria. Patients were diagnosed from 6/1/2007 to 11/15/2016. Median age of diagnosis was 62, with range 19-87. The most common NHL subtype was diffuse large B-cell lymphoma (93%). Patients were primarily treated with R-CHOP (63%) or R-EPOCH (34%) as first-line therapy for a median of 6 cycles, with 90% achieving complete response, 5% partial response, and 5% progressive disease. At the time of diagnosis, 13% of patients had a known diagnosis of osteopenia, osteoporosis, or prior fracture. Baseline clinical characteristics and treatment information are described in Table 1.Of the 82 patients, 23 (28%) were found to have prevalent fractures at the time of diagnosis, with predominantly vertebral fractures. Of those with prevalent fractures, only 5 had a known diagnosis of osteoporosis or prior fracture. After treatment initiation, 2 patients developed progressive fractures and 8 (10%) patients developed new incident fractures, including 5 patients who had prevalent fractures. Compared to those who did not have prevalent fractures, patients with prevalent fractures were more likely to be older (70.9 vs 53.9, p<0.0001) and have a diagnosis of osteopenia, osteoporosis, or prior fracture at baseline (p=0.037). Patients with prevalent fractures also exhibited a trend towards more advanced stage (p=0.052) and higher international prognostic index score (p=0.060).ConclusionsUsing a novel approach of reviewing routinely performed pre- and post-treatment CT scans with sagittal and coronal reconstructions for the evaluation of bone health, we found that newly diagnosed patients with aggressive B-cell NHL have a 28% prevalence of fractures at diagnosis and 10% incidence of new fractures within 2 years of treatment. These rates greatly exceed the reported 15% prevalence of vertebral fractures and 0.5% annual incidence in the general population aged 65-70 (J Bone Miner Res. 2005 Jan;20(1):131-40). The high prevalence of fractures at diagnosis suggests a disease-related process that compromises bone health, and treatment-related bone loss further increases the risk of fractures. In ongoing studies, we seek to use CT-derived measures of bone mineral density and other clinical characteristics to derive a prediction score to identify patients at high risk of developing incident fractures who may benefit from preventative therapies. [Display omitted] DisclosuresAi:Celgene: Research Funding. Andreadis:Amgen: Research Funding; Genentech Inc.: Employment, Equity Ownership, Honoraria; Cellerant Therapeutics: Research Funding; Astellas: Honoraria; Novartis Pharmaceuticals Corporation: Honoraria, Research Funding; Pharmacyclics: Research Funding; Incyte Pharmaceuticals: Research Funding; Gilead Sciences: Honoraria; Seattle Genetics: Honoraria.

Risk of secondary malignancies in non-Hodgkin lymphoma survivors: 40 years of follow-up assessed by treatment modality.

e19525 Background: Survivors of non-Hodgkin lymphoma (NHL) are at increased risk of secondary malignancies (SM). We quantified this risk in survivors with over 40 years of follow-up, and evaluated differences in risk by treatment modality. Methods: Standardized incidence ratios (SIR, observed-to-expected [O/E] ratio), which accounts for patient years at risk, and absolute excess risk of SM were assessed in 142,837 patients diagnosed with NHL as a first malignancy between 1975 and 2016 in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Follow up was available through 2016. Non-melanoma skin cancers were not counted as SM. SIRs were also evaluated for patients stratified by age at and latency from diagnosis. Results: In all, 14,101 patients received radiotherapy alone (RT), 68,424 received chemotherapy alone (CT), and 18,339 received chemotherapy and radiation (CRT). In total, 15,979 patients (11%) developed SM, more than the endemic rate (O/E 1.29; P &lt; .01). Overall, patients treated with any RT (RT+CRT) had a similar risk of SM as those who did not receive RT (O/E 1.29 for both compared to endemic rate). Patients treated with RT had more risk of female breast cancer and less risk of leukemia than unirradiated patients (P &lt; .05). Patients treated with any CT (CT+CRT) had increased SM rates compared with those who did not receive CT [O/E 1.33 (95% CI 1.30-1.35) vs 1.24 (95% CI 1.21-1.26), respectively], which included increased risks of leukemia, Kaposi sarcoma, kidney, pancreas, rectal, head and neck, and colon cancers and decreased risk of prostate cancer (P &lt; 0.05). When stratified by four treatment groups (no CT or RT, RT alone, CT alone, CRT), there were no differences in SM rates between the no therapy and RT alone groups (O/E 1.24 95% CI 1.21-1.27 and O/E 1.23 95% CI 1.18-1.28 respectively). CT alone and CRT were associated with increased risk of secondary malignancy compared to the no therapy group (O/E 1.32 95% CI 1.29-1.35 and O/E 1.35 95% CI 1.29-1.40 respectively). CT alone was also associated with increased risk of leukemia, Kaposi sarcoma, kidney, head and neck and thyroid cancers, and a decreased risk of prostate cancer (P &lt; .05). CRT was associated with increased risk of head and neck and female breast cancers (P &lt; .05). There was no difference in the overall risk of SM between the CT alone and CRT groups and female breast cancer was the only site at which CRT was associated with higher risk than CT alone. Of note, female breast cancer risk was highest in those diagnosed under 25 years of age and at latencies of greater than 10 years. Conclusions: This is the largest study to examine secondary malignancy risk in patients with NHL and has the longest follow-up. Patients treated with RT alone did not have an increased SM risk compared to those who received no RT or CT. The risk of SMs was increased overall for NHL survivors and varied with treatment modality.

Cardiovascular disease risks in younger versus older adult B-cell non-Hodgkin's lymphoma survivors.

IntroductionYoung cancer survivors may be at increased risk of early‐onset chronic health conditions. The aim of this population‐based study is to estimate cardiovascular disease (CVD) risk among younger versus older B‐cell non‐Hodgkin's lymphoma (B‐NHL) survivors compared with their respective general population cohorts.MethodsB‐NHL survivors diagnosed from 1997 to 2015 in the Utah Cancer Registry were matched with up to five cancer‐free individuals on birth year, sex, and birth state, using the statewide Utah Population Database. Electronic medical records and statewide health care facility data were used to identify disease outcomes ≥5 years after cancer diagnosis. Cox Proportional Hazards models were used to estimate hazard ratios for B‐NHL survivors diagnosed at <65 years and ≥65 years old.ResultsYounger B‐NHL survivors had higher relative risks than older cancer survivors of chronic rheumatic disease of the heart valves (HR = 4.14, 99% CI = 2.17–7.89; P valueheterogeneity = 0.004); peri‐, endo‐, and myocarditis (HR = 2.43, 99% CI = 1.38–4.28; P valueheterogeneity = 0.016); diseases of the arteries (HR = 1.63, 99% CI = 1.21–2.21; P valueheterogeneity = 0.044); and hypotension (HR = 2.44, 99% CI = 1.58–3.75; P valueheterogeneity = 0.048). B‐NHL survivors of both age groups had elevated relative risks of heart disease overall and congestive heart failure.ConclusionYounger B‐NHL survivors had higher risks than older B‐NHL survivors of specific cardiovascular diseases compared to their respective general population cohorts.

Quality of life and fear of cancer recurrence in patients and survivors of non-Hodgkin lymphoma

ABSTRACT Non-Hodgkin lymphoma (NHL) is a common haematological cancer that is comprised of approximately 30 subtypes, of which Waldenström Macroglobulinemia (WM) is a rare incurable form. It is typically managed using a watch-and-wait strategy that can contribute to illness uncertainty which may result in fear of cancer recurrence (FCR) and poor health-related quality of life (QOL). However, few studies have examined the correlates of FCR and QOL in NHL patients, including WM patients. One-hundred males and 92 females with a mean age of 62.7 years who were an average of 6.8 years from diagnosis completed the online questionnaire which asked about demographics, medical history, QOL, FCR, stress, anxiety and depression. Few NHL patients reported significant stress or affective distress, most had moderate-high QOL and 41% experienced recent FCR, relative to published cut-off scores. Poorer QOL was related to depression symptoms, FCR, higher illness burden (i.e. comorbidity) and fewer personal resources (i.e. unemployed), whereas FCR was related to shorter time since diagnosis and more depressive symptoms. Results suggest that FCR and depressive symptoms may adversely impact QOL, whereas a recent cancer diagnosis and depression-related pessimism may contribute to FCR.

Exploring health-related quality of life among non-Hodgkin's lymphoma survivors after completion of primary treatment: a cross-sectional study in Thailand.

To investigate health-related quality of life (HR-QoL) and its influencing factors among non-Hodgkin's lymphoma (NHL) survivors after completion of primary treatment. A cross-sectional study with 312 NHL survivors after completing primary treatment using self-reported data collected through face-to-face interviews or postal survey between May 2019 and December 2019. Sociodemographic factors, clinical characteristics, physical symptom distress, anxiety, depression, unmet supportive care needs, and adaptation (post-traumatic growth and post-traumatic stress disorder) were assessed. Data analysis included ANOVA tests to investigate HR-QoL among NHL survivors at different time points and GEE to assess predictors of HR-QoL. The mean score of HR-QoL was 136.05 (SD 19.12). HR-QoL scores reported by NHL survivors in phase I (6months or less post-treatment) were significantly lower than those in phase II (> 6months-4years), phase III (> 4-9years), and phase IV (over 9years post-treatment). Regarding HR-QoL domains, NHL survivors in phase I had significantly lower physical well-being and functional well-being scores than those in phases II, III, and IV; and significantly lower lymphoma domain score than those in phase III. GEE analysis showed that physical symptom distress, anxiety, depression, unmet supportive care needs, poor adaptation, and receiving chemotherapy disrupted HR-QoL (all P < .001). Healthcare providers should re-prioritize intervention guidelines and survivorship care planning to promote HR-QoL among NHL survivors, particularly in phase I, through reducing physical and psychological symptom distress, addressing unmet needs, and enhancing adaptation outcomes.

Cognitive Impairment in Survivors of Pediatric Extracranial Solid Tumors and Lymphomas

Article Tools REVIEW ARTICLES Neurocognitive Outcomes in Survivors of Pediatric Cancer Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.20.02358 Journal of Clinical Oncology - published online before print April 22, 2021 PMID: 33886354 Cognitive Impairment in Survivors of Pediatric Extracranial Solid Tumors and Lymphomas Rebecca Foster , PhD1,2xRebecca FosterSearch for articles by this author; Daniel J. Zheng, MD, MHS3xDaniel J. ZhengSearch for articles by this author; Kelli L. Netson-Amore , PhD4xKelli L. Netson-AmoreSearch for articles by this author; and Nina S. Kadan-Lottick , MD, MSPH5xNina S. Kadan-LottickSearch for articles by this author Show More 1St Louis Children's Hospital, St Louis, MO2Washington University, St Louis, MO3Boston Children's Hospital, Boston, MA4University of Kansas School of Medicine-Wichita, Wichita, KS5Yale University School of Medicine and Yale Cancer Center, New Haven, CT https://doi.org/10.1200/JCO.20.02358 First Page Full Text PDF Figures and Tables © 2021 by American Society of Clinical OncologyCONTEXTKey ObjectiveAre cognitive outcomes impaired in survivors of childhood extracranial solid tumors and lymphomas? In our critical review of the literature, we explored cognitive functioning after specific extracranial solid tumor and lymphoma diagnoses, discussed possible associated risk factors, highlighted research gaps, and provided clinical guidance for affected survivors.Knowledge GeneratedExisting studies suggest that survivors of osteosarcoma, neuroblastoma, Wilms tumor, non-Hodgkin lymphoma, Hodgkin lymphoma, and Langerhans cell histiocytosis have increased risk of cognitive impairment. Co-morbid health conditions were frequently associated with cognition.RelevanceGiven the older age at diagnosis of many childhood extracranial solid tumors and lymphomas as well as toxicities associated with certain therapies, patients may benefit from vocational services, occupational therapy, physical therapy, and/or hearing or visual rehabilitation in addition to surveillance for cognitive difficulties.AUTHOR CONTRIBUTIONSConception and design: Rebecca Foster, Kelli L. Netson-Amore, Nina S. Kadan-LottickAdministrative support: Nina S. Kadan-LottickCollection and assembly of data: Daniel J. Zheng, Kelli L. Netson-Amore, Nina S. Kadan-LottickData analysis and interpretation: Daniel J. ZhengManuscript writing: All authorsFinal approval of manuscript: All authorsAccountable for all aspects of the work: All authorsAUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTERESTCognitive Impairment in Survivors of Pediatric Extracranial Solid Tumors and LymphomasThe following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).Nina S. Kadan-LottickHonoraria: Medtronic, Boston ScientificConsulting or Advisory Role: Medtronic, Boston ScientificSpeakers' Bureau: Medtronic, Boston ScientificNo other potential conflicts of interest were reported.

Characterization of subclinical diastolic dysfunction by cardiac magnetic resonance feature-tracking in adult survivors of non-Hodgkin lymphoma treated with anthracyclines

BackgroundThe use of anthracycline-based chemotherapy is associated with the development of heart failure, even years after the end of treatment. Early detection of cardiac dysfunction could identify a high-risk subset of survivors who would eventually benefit from early intervention. Cardiac magnetic resonance feature-tracking (CMR-FT) analysis offers a practical and rapid method to calculate systolic and diastolic strains from routinely acquired cine images. While early changes in systolic function have been described, less data are available about late effects of chemotherapy in diastolic parameters by CMR-FT. The main goal of this study was to determine whether left ventricular (LV) early diastolic strain rates (GDSR-E) by CMR-FT are impaired in long-term adult survivors of non-Hodgkin lymphoma (NHL). Our secondary objective was to analyze associations between GDSR-E with cumulative anthracycline dose, systolic function parameters and myocardial tissue characteristics.MethodsThis is a single center cross-sectional observational study of asymptomatic patients in remission of NHL who previously received anthracycline therapy. All participants underwent their CMR examination on a 3.0-T scanner, including cines, T2 mapping, T1 mapping and late gadolinium enhancement imaging. Derived myocardial extracellular volume fraction was obtained from pre- and post-contrast T1 maps. CMR-FT analysis was performed using Trufi Strain software. The data obtained were compared between anthracycline group and volunteers without cardiovascular disease or neoplasia.ResultsA total of 18 adult survivors of NHL, 14 (77.8%) males, at mean age of 57.6 (± 14.7) years-old, were studied 88.2 (± 52.1) months after exposure to anthracycline therapy (median 400 mg/m2). Compared with controls, anthracycline group showed impaired LV global early diastolic circumferential strain rate (GCSR-E) [53.5%/s ± 19.3 vs 72.2%/s ± 26.7, p = 0.022], early diastolic longitudinal strain rate (GLSR-E) [40.4%/s ± 13.0 vs 55.9%/s ± 17.8, p = 0.006] and early diastolic radial strain rate (GRSR-E) [− 114.4%/s ± 37.1 vs − 170.5%/s ± 48.0, p < 0.001]. Impaired LV GCSR-E, GLSR-E and GRSR-E correlated with increased anthracycline dose and decreased systolic function. There were no correlations between GDSR-E and myocardial tissue characteristics.ConclusionsLeft ventricular early diastolic strain rates by CMR-FT are impaired late after anthracycline chemotherapy in adult survivors of non-Hodgkin lymphoma.

Risk of infertility in female adolescents and young adults with cancer: a population-based cohort study.

STUDY QUESTIONDo female adolescents and young adults (AYAs) with cancer have a higher risk of subsequent infertility diagnosis than AYAs without cancer?SUMMARY ANSWERFemale AYAs with breast, hematological, thyroid and melanoma cancer have a higher risk of subsequent infertility diagnosis.WHAT IS KNOWN ALREADYCancer therapies have improved substantially, leading to dramatic increases in survival. As survival improves, there is an increasing emphasis on optimizing the quality of life among cancer survivors. Many cancer therapies increase the risk of infertility, but we lack population-based studies that quantify the risk of subsequent infertility diagnosis in female AYAs with non-gynecological cancers. The literature is limited to population-based studies comparing pregnancy or birth rates after cancer against unexposed women, or smaller studies using markers of the ovarian reserve as a proxy of infertility among female survivors of cancer.STUDY DESIGN, SIZE, DURATIONWe conducted a population-based cohort study using universal health care databases in the province of Ontario, Canada. Using data from the Ontario Cancer Registry, we identified all women 15–39 years of age diagnosed with the most common cancers in AYAs (brain, breast, colorectal, leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, thyroid and melanoma) from 1992 to 2011 who lived at least 5 years recurrence-free (Exposed, n = 14,316). Women with a tubal ligation, bilateral oophorectomy or hysterectomy previous to their cancer diagnosis were excluded. We matched each exposed woman by age, census subdivision, and parity to five randomly selected unexposed women (n = 60,975) and followed subjects until 31 December 2016.PARTICIPANTS/MATERIALS, SETTING, METHODSInfertility diagnosis after 1 year of cancer was identified using information on physician billing codes through the Ontario Health Insurance Plan database (ICD-9 628). Modified Poisson regression models were used to assess the risk of infertility diagnosis (relative risk, RR) adjusted for income quintile and further stratified by parity at the time of cancer diagnosis (nulliparous and parous).MAIN RESULTS AND THE ROLE OF CHANCEMean age at cancer diagnosis was 31.4 years. Overall, the proportion of infertility diagnosis was higher in cancer survivors compared to unexposed women. Mean age of infertility diagnosis was similar among cancer survivors and unexposed women (34.8 years and 34.9 years, respectively). The overall risk of infertility diagnosis was higher in cancer survivors (RR 1.30; 95% CI 1.23–1.37). Differences in infertility risk varied by type of cancer. Survivors of breast cancer (RR 1.46; 95% CI 1.30–1.65), leukemia (RR 1.56; 95% CI 1.09–2.22), Hodgkin lymphoma (RR 1.49; 95% CI 1.28–1.74), non-Hodgkin lymphoma (RR 1.42; 95% CI 1.14, 1.76), thyroid cancer (RR 1.20; 95% CI 1.10–1.30) and melanoma (RR 1.17; 95% CI 1.01, 1.35) had a higher risk of infertility diagnosis compared to women without cancer. After stratification by parity, the association remained in nulliparous women survivors of breast cancer, leukemia, lymphoma and melanoma, whereas it was attenuated in parous women. In survivors of thyroid cancer, the association remained statistically significant in both nulliparous and parous women. In survivors of brain or colorectal cancer, the association was not significant, overall or after stratification by parity.LIMITATIONS, REASONS FOR CAUTIONNon-biological factors that may influence the likelihood of seeking a fertility assessment may not be captured in administrative databases. The effects of additional risk factors, including cancer treatment, which may modify the associations, need to be assessed in future studies.WIDER IMPLICATIONS OF THE FINDINGSReproductive health surveillance in female AYAs with cancer is a priority, especially those with breast cancer, leukemia and lymphoma. Our finding of a potential effects of thyroid cancer (subject to over-diagnosis) and, to a lesser extent, melanoma need to be further studied, and, if an effect is confirmed, possible mechanisms need to be elucidated.STUDY FUNDING/COMPETING INTEREST(S)Funding was provided by the Faculty of Health Sciences and Department of Obstetrics and Gynecology, Queen’s University. There are no competing interests to declare.TRIAL REGISTRATION NUMBERN/A

Quality of life and related demographic factors in long-term survivors of childhood non-Hodgkin's lymphoma.

To evaluate the quality of life and related demographic factors in long-term survivors of childhood non-Hodgkin's lymphoma (NHL). A retrospective analysis was performed on the medical and demographic data of the NHL patients who received treatment in the Sun Yat-sen University Cancer Center and achieved long-term survival at follow-up, with an age of <18 years at initial diagnosis and a present age of ≥18 years. A questionnaire survey was performed using 36-Item Short-Form Health Survey (SF-36) and the symptom subscale of the Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30). The health status of long-term survivors of NHL was evaluated by comparing the scores of various dimensions of the SF-36 scale of general adult population in the United States (American norm) and those of the SF-36 scale of general adult population in Hong Kong, China (Hong Kong norm). The correlation between the score of each dimension of the scale and demographic characteristics was evaluated. The symptoms of long-term NHL survivors were evaluated according to the score of QLQ-C30 scale. A total of 23 patients with NHL with complete follow-up data were enrolled. The pathological types included diffuse large B-cell lymphoma in 10 patients, Burkitt lymphoma in 4 patients, T-cell lymphoblastoma in 5 patients, B-cell lymphoblastoma in 3 patients, and natural killer/T cell lymphoma in 1 patient. All patients received the chemotherapy regimen containing anthracyclines and alkylating agents. The median present age was 26.2 years (range: 16.9-55.8 years), and the median age at initial diagnosis was 10.4 years (range: 2.4-17.6 years). Among the 23 patients, 6 were married and had children and 2 had chronic diseases. There was no significant difference between the long-term survivors and the US norm in role physical, general health, role-emotional, and mental health (P>0.05), while the long-term survivors had significantly better scores of the other dimensions than the US norm (P<0.05). Similar results were obtained for the comparison between the long-term survivors and the China Hong Kong norm. Age at initial diagnosis was negatively correlated with the scores of social functioning, role physical, and general health in the SF-36 scale (P<0.05), and the present age of patients was positively correlated with the score of physical functioning and was negatively correlated with the score of general health (P<0.05). The urban and rural distribution of patients was related to the general health status (P<0.05). In addition, the long-term survivors of childhood NHL had relatively low scores of the symptom domain of QLQ-C30, and few moderate or severe symptoms were found. Long-term survivors of childhood NHL tend to have a good overall health status, with no significant differences compared with the general population. Age at initial diagnosis is the main demographic factor that affects patients' quality of life. Citation.

Associations between baseline demographic, clinical and lifestyle factors, and changes in fatigue, depression, and health-related quality of life in long-term cancer survivors: a cohort study

To investigate the longitudinal associations between demographic, clinical and lifestyle factors, and changes in patient-reported outcomes (PROs) in cancer survivors 6-9years post-diagnosis in Western Australia. A total of 290 individuals participated in this study. Three-quarters of participants were female, and 55%, 31%, and 14% were survivors of breast cancer, colon cancer, and non-Hodgkin lymphoma (NHL), respectively. PROs (fatigue, depression, and health-related quality of life (HRQOL)) were reported at two time points (2012-13 and 2017). Descriptive statistics were used to assess the overall changes over time and linear mixed models were used to identify factors associated with changes over time, after adjusting for confounders. No significant changes were observed in PROs between time point 1 and follow-up at the population level, yet a notable proportion of participants (23% for fatigue, 10% for depression, and 39% for HRQOL) reported a negative minimal clinically important difference (MCID). Being non-Caucasian and having had NHL were associated with negative changes over time. Being obese and having had radiotherapy were related to improved outcomes. Cancer survivors whose levels of fatigue, depression, and quality of life are compromised during cancer treatment may require intervention even 6-9years post-treatment. Our results suggest particular attention should be paid to those who are non-Caucasian and who have had NHL. This is crucial for providing appropriate care and to support those who are at increased risk of deteriorating naturally over time.

Semen quality in non-Hodgkin lymphoma survivors: a monocentric retrospective study.

How is semen quality affected by treatment in survivors of non-Hodgkin lymphoma (NHL)? Before cancer treatment, most NHL subjects were normozoospermic and, while standard first-line treatments seemed compatible with post-treatment recovery after 18 months, salvage therapy followed by haematopoietic stem cell transplant caused permanent damage to spermatogenesis in many cases, with 66% azoospermic subjects in the long term. Testicular function has been widely investigated in relation to the most common malignancies in men of reproductive age, such as testicular cancer and Hodgkin lymphoma, but NHL has been somewhat under-investigated. The available reports generally show a post-treatment worsening of semen parameters in NHL survivors, but they involved small caseloads or a subgroup of broader caseloads, and their results are not comparable. We conducted a retrospective analysis of 222 subjects who attended our University Hospital Sperm Bank between 2002 and 2017 for sperm cryopreservation after a diagnosis of NHL. The study included 222 patients with NHL who underwent sperm cryopreservation before any antineoplastic treatment. Subjects with any comorbidity and/or other conditions interfering with sperm parameters were excluded. All patients underwent a careful medical history and physical examination at the time of sperm cryopreservation (T0) and had at least one follow-up visit at 6 (T6), 12 (T12), 18 (T18) and/or 24 months (T24) or more than 24 months (T > 24), with a median follow-up of 47.5 months (range 28-140 months). Fertility information was collected through the administration of a questionnaire. Pre-treatment, more than 80% of NHL patients were normozoospermic and in 15.9% of cases had already fathered a child. Aggressive lymphomas were associated with worse baseline semen volume and total sperm number compared to indolent subtypes (P < 0.05). Post-treatment analyses showed that standard first-line treatments alone had a more favourable outcome than intensified regimens for semen parameters, with total sperm number returning to near-baseline values at 18 months (T0: 195.0 ± 189.8 versus T18: 113.4 ± 103.1, P = 0.278), and a 7.7% prevalence of azoospermia at 2 years. In this subgroup receiving standard first-line treatments, radiotherapy of the pelvis versus other 'high' sites (mediastinum, latero-cervical and axillary lymph nodes, etc.) was associated with an increased risk of developing post-treatment azoospermia (odds ratio 4.29, 95% CI 1.81-10.14; P = 0.001). Two-thirds of subjects who had relapsed or had disease progression after first-line treatment and then underwent salvage treatment ± haematopoietic stem cell transplant became azoospermic. Fertility data were available for 176 patients: 15.9% already had at least one child prior to the NHL diagnosis and 12.5% (22 patients) desired children after treatment. Fourteen patients achieved fatherhood: 12 through natural conception and two following ART. The main limitations of the study are the lack of data on blood hormones for evaluation of testicular function as a whole and the non-compliance of several patients in attending follow-up visits at all time points, resulting in a reduced sample size for the treatment subgroup analyses. Furthermore, despite a good fertility questionnaire response rate (>80%), the low number of NHL survivors actively seeking fatherhood limits the generalization of results. The increased survival of NHL patients of reproductive age makes it essential to focus on the testicular toxicity of the treatment. Sperm cryopreservation must be suggested before any treatment. Two years after first-line treatments, sperm number showed signs of recovery: this finding is of the utmost importance for oncofertility counselling, as it indicates that only a standard first-line chemotherapy in many patients may be compatible with at least a partial spermatogenesis recovery in the long term. Nonetheless, it is expected that up to 30% of subjects will require treatment intensification, which could result in permanent testicular damage; in such cases the use of banked semen might represent the patient's best chance for future fertility. This work was supported by a grant from the Italian Ministry of Education and Research (MIUR-PRIN 2015-2015XSNA83-002) and the 'Sapienza' University of Rome, Faculty of Medicine. The authors report no conflicts of interest. N/A.

Hospitalization Patterns and Medicare Spending for Non-Malignant Morbidity Among Older Survivors of Non-Hodgkin Lymphoma (NHL)

Introduction: Growth in the number of older cancer survivors in the face of projected healthcare workforce shortages is challenging the US health-care system in delivering appropriate care. A risk-stratified approach based on burden of morbidity and healthcare expertise is urgently needed to provide efficient and cost-effective care. We examined the cumulative, non-malignant, condition-specific hospitalization rates and associated spending in older NHL survivors compared to non-cancer controls, using a population-based approach, to develop evidence for risk-stratified care. Methods: Using SEER-Medicare data, we identified 14,533 patients diagnosed with NHL at age &amp;gt;65y (2008-2015). An age, race, sex, and follow-up time comparable non-cancer cohort (n=14,533) was also identified. Hospitalizations for 10 health conditions were used to examine cumulative utilization burden of non-malignant morbidity by time from diagnosis to 5y or date of bone marrow transplant (whichever came first), censoring at 6 mo prior to death or end-of-study (12/31/2016). We estimated the average number of hospitalizations per 100 individuals, up to 1y and 5y, accounting for the competing risk of leaving the cohort (BMT or 6 months prior to death). We calculated incident rate ratios [IRR] per person-time comparing NHL patients to controls controlling for pre-cancer comorbidity, Dual Medicaid-Medicare coverage, race/ethnicity, and pre-NHL hospitalization. We calculated Medicare spending per hospitalization and per person-year (adjusted to 2016 pricing), defining high hospitalization or high spending using the 90th percentile cutpoint for predicted hospitalization or spending. Results: Hospitalization: In Fig 1, we summarize the average number of condition-specific hospitalizations/100 individuals by 1y and by 5y. Adjusting for demographics and pre-existing comorbidity, NHL patients were significantly more likely to be hospitalized when compared with controls (IRR1y=3.08, IRR5y=1.54, all p&amp;lt;0.001). Compared with controls, NHL patients were at higher risk for hospitalizations related to cardiovascular disease (IRR1y=3.08, IRR5y=1.54, all p&amp;lt;0.001), age-related conditions (IRR1y=7.14, IRR5y=2.53, all p&amp;lt;0.001), gastrointestinal (GI) disease (IRR1y=5.84, IRR5y=2.30, all p&amp;lt;0.001), and pulmonary conditions (IRR1y=3.06, IRR5y=1.36, p&amp;lt;0.001). Factors associated with high hospitalization rates included a diagnosis of diffuse large B cell lymphoma (RR=6.36, p&amp;lt;0.001) and ≥2 pre-existing comorbidities (RR=10.1, p&amp;lt;0.001), non-white race/ethnicity (Black: RR=1.74, p&amp;lt;0.001; Hispanic (RR=1.97, p&amp;lt;0.001), residence in low-education area (RR=1.49, p&amp;lt;0.001) or low-income area (RR=37, p&amp;lt;0.001), or rural residence (RR=1.38, p&amp;lt;0.001). The high-hospitalization subgroup (n=1,435) had 3.24 times the hospitalization rate when compared with the lowest-hospitalization subgroup (p&amp;lt;0.001). Spending: Average hospitalization spending per person-year was higher in the NHL cohort (Y1: $8,178 vs. $1,621; 5y: $3,805 vs. $1,543) when compared with non-cancer controls (Fig 2). The average spending per hospitalization over 5y was also higher for the NHL cohort ($16,950 vs. $13,474, Fig 3). Pulmonary conditions were associated with the largest per hospitalization spending differential between NHL and controls ($18k vs. $9k). Other per hospitalization spending disparities between NHL patients and controls included GI disease ($17.8k vs. $10.2k) and age-related conditions ($12.6k vs. $7.9k). The NHL high-spending group was similar to the high-hospitalization group (71% overlap). The highest spending group had 2.5 times the spending compared with the lowest spending (10th percentile) group (p&amp;lt;0.001). Conclusions: Medicare beneficiaries diagnosed with NHL experience significantly greater rates of non-malignant hospitalizations and spending compared to their non-cancer counterparts. These hospitalizations are related to cardiovascular disease, gastrointestinal disease, pulmonary complications and aging-related conditions. Non-white DLBCL patients from lower SES with ≥2 comorbidities and living in rural areas were at greatest risk of high hospitalization and spending, providing evidence for a targeted risk-stratified care. Disclosures Mehta: Seattle Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Roche-Genentech: Research Funding; Merck: Research Funding; TG Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Affimed: Research Funding; Takeda: Research Funding; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Innate Pharmaceuticals: Research Funding; fortyseven Inc/Gilead: Research Funding; Juno Parmaceuticals/BMS: Research Funding; Gelgene/BMS: Research Funding; Oncotartis: Research Funding; Kite/Gilead: Research Funding.

Abstract 5803: Cardiovascular disease risks in younger and older B-cell non-Hodgkin's lymphoma survivors

Abstract Introduction. Non-Hodgkin's lymphoma (NHL) is the fifth most common cancer in the United States. B-cell lymphoma accounts for 80-90% of NHL cases. Younger age at cancer diagnosis is associated with higher survival rates. However, younger cancer survivors may experience accelerated aging due to the cancer treatment that they undergo. The aim of this population-based study is to estimate long-term cardiovascular risk among younger and older adult NHL survivors compared to their respective general population cohorts. Methods. B-cell non-Hodgkin's lymphoma (B-NHL) survivors diagnosed from 1997 to 2015 in the Utah Cancer Registry were matched with up to five cancer-free individuals on birth year, sex, birth state, using the statewide Utah Population Database. Electronic medical records and statewide healthcare facility data were used to identify disease outcomes 5 years or more after cancer diagnosis. Cox Proportional Hazards models were used to estimate hazard ratios (HR). Test for heterogeneity was used to compare the HR for the older and younger cohorts. Results. There were 2,146 B-NHL survivors (1,284 diagnosed &amp;lt;65 years old and 862 diagnosed ≥65 years old) and 13,880 individuals from the general population ≥5 years after cancer diagnosis. Both younger and older B-NHL survivors had elevated risks for congestive heart failure, respectively (HRyounger = 1.65, 99% CI = 1.07-2.56; HRolder = 1.40, 99% CI = 1.01-1.96) compared to their respective general population cohorts. The younger B-NHL cohort had higher relative risks for chronic rheumatic disease of the heart valves (HRyounger = 2.87, 99% CI=1.64-5.02; HRolder=1.17, 99% CI=0.73-1.90; p-valueheterogeneity = 0.017), peri-; endo-; and myocarditis (HRyounger =2.26, 99%CI=1.34-3.79; HRolder = 0.80, 99% CI=0.46-1.39; p-value heterogeneity = 0.007), and cardiomyopathy (HRyounger=2.14, 99%CI=1.18-3.91; HRolder=0.93, 99%CI=0.51-1.72; p-valueheterogeneity= 0.056) than the older cohort. For other CVD outcomes, increased risks were observed in the younger B-NHL survivors and not in the older B-NHL survivors, but these differences were not statistically significant. Smoking and baseline obesity were major long-term risk factors of heart disease among younger B-NHL survivors. First course cancer treatment was not associated with cardiovascular disease risks ≥5 years after cancer diagnosis among B-NHL survivors. Conclusion. Elevated long-term risk for congestive heart failure was observed in B-NHL survivors compared to the general population. Younger B-NHL survivors had higher relative risks than older B-NHL survivors for chronic rheumatic heart disease, peri-; endo-; and myocarditis, and cardiomyopathy compared to their respective general population cohort groups. Although these increased disease risks suggest some early aging for young B-NHL survivors, most cardiovascular disease risks were not different between the two age groups. Citation Format: Krista Ocier, Sarah Abdelaziz, Seungmin Kim, Kerry Rowe, John Snyder, Vikrant Deshmukh, Michael Newman, Alison Fraser, Ken Smith, Kimberly Herget, Christy Porucznik, Kimberley Shoaf, Joseph Stanford, Catherine Lee, Mia Hashibe. Cardiovascular disease risks in younger and older B-cell non-Hodgkin's lymphoma survivors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5803.