Jill A Bell

Systematic Literature Review of Treatment Options and Clinical Outcomes for Patients With Higher-Risk Myelodysplastic Syndromes and Chronic Myelomonocytic Leukemia

Abstract High‐dose chemotherapy with allogeneic hematopoietic stem cell transplantation (allo‐HSCT) can produce long‐term remission in patients with higher‐risk myelodysplastic syndromes (HR‐MDS) and chronic myelomonocytic leukemia (CMML). However, this treatment regimen is not appropriate for elderly and/or comorbid patients; in these cases, azacitidine is a standard treatment. This systematic review was conducted to evaluate real‐world evidence of treatment options for patients with HR‐MDS/CMML. Medline and Embase (January 2006 to May 2016) were searched, in addition to conference proceedings and treatment guideline reviews. Studies on clinical effectiveness/efficacy outcomes with a sample size ≥50 patients were included. From 1061 unique citations identified, 87 full‐text articles were reviewed, of which 24 articles reported at least 1 outcome of interest. Studies showed that HR‐MDS/CMML patients treated with a conventional chemotherapy regimen (CCR) have poorer overall survival (OS). Key findings from individual HR‐MDS studies showed improved survival with azacitidine over CCRs and higher overall response rates with clofarabine relative to low‐dose cytosine arabinoside (but no significant difference in 2‐year OS favoring clofarabine). OS was highest for patients treated with allo‐HSCT. Findings indicate limited real‐world data on treatment strategies available for HR‐MDS/CMML patients. Most studies address the effect of chemotherapy or allo‐HSCT on clinical outcomes, so are not applicable to elderly/comorbid patients who are too frail for those treatments. In particular, our analysis revealed limited evidence on viable options after failure of treatment with azacitidine, identifying a significant unmet need in this patient population.

Gastrointestinal adverse events with combination of checkpoint inhibitors in advanced melanoma: a systematic review

Introduction: Immunotherapies, including checkpoint inhibitors (CIs) such as cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed death-1 (PD-1) inhibitors, are revolutionizing the treatment of advanced melanoma. Combining CTLA-4 and PD-1 inhibitors provides additional clinical benefit compared with single agents alone. However, combination therapy can increase the incidence of gastrointestinal adverse events (GI AEs). This systematic review assessed the epidemiological, clinical, economic, and humanistic burden of GI AEs due to combination CIs in advanced melanoma. Methods: MEDLINE, EMBASE, and the Cochrane Library were systematically searched (December 2011 to December 2016) to identify primary studies, systematic reviews, meta-analyses, and conference proceedings (2014–2016) evaluating adults treated with ≥2 CIs for advanced melanoma. Results: Of the 3391 identified articles, 14 were included. Most studies examined the ipilimumab plus nivolumab combination. Any grade and grade 3–4 GI AEs occurred in more patients receiving ipilimumab plus nivolumab versus ipilimumab or nivolumab alone. The most common grade 3–4 GI AEs were diarrhea and colitis. Grade 3–4 colitis occurred in more patients receiving ipilimumab plus nivolumab. However, grade 3–4 diarrhea occurred at the same rate as ipilimumab alone. GI AEs developed with ipilimumab plus nivolumab approximately 6.6 weeks after initiating treatment. No studies assessing the economic or humanistic burden of GI AEs were identified. Conclusion: GI AEs occurred at a higher rate and greater severity in patients treated with ipilimumab plus nivolumab versus ipilimumab or nivolumab monotherapy. The lack of research on economic and humanistic burden of GI AEs with combination CIs for advanced melanoma represents an unmet need in the literature and should be explored in future studies.

Economic burden of elderly patients with acute myeloid leukemia treated in routine clinical care in the United States

This retrospective claims database study examined healthcare utilization (HCU) and costs associated with acute myeloid leukemia (AML) in 237 elderly patients who received chemotherapy or a stem cell transplant (SCT) following AML diagnosis. Patients with secondary AML were excluded. Over the entire follow-up period, 92.0% of patients had ≥1 inpatient admission; 85.7% had ≥1 AML-related admission, and 42.6% had ≥1 non-AML-related admission. During inpatient admissions, 39.2% of patients had ≥1 intensive care unit (ICU) admission, with 20.7% having ≥1 AML-related ICU admission, and 27.8% having ≥1 non-AML-related ICU admission. Total mean per-patient per-month (PPPM) costs over the follow-up period were

Transfusion-free interval is associated with improved survival in patients with higher-risk myelodysplastic syndromes engaged in routine care

25,243 (SD:

Systematic review of therapy used in relapsed or refractory diffuse large B-cell lymphoma and follicular lymphoma

21,909), with costs from Year 1 (

Economic burden of patients with diffuse large B-cell and follicular lymphoma treated in the USA

27,756 [SD:

Effectiveness and Safety of Therapeutic Regimens for Elderly Patients With Acute Myeloid Leukemia: A Systematic Literature Review

22,121]) more than double those in Year 2 (

Economic Burden of Patients Treated for Higher-Risk Myelodysplastic Syndromes (HR-MDS) in Routine Clinical Care in the United States

12,953 [SD:

Systematic Review of Therapy Used in Higher-Risk (HR) Myelodysplastic Syndromes (MDS) and Chronic Myelomonocytic Leukemia (CMML)

26,334]) following AML diagnosis. The majority of total costs were medical (

Survival Outcomes after First-Line Therapy in Higher-Risk Myelodysplastic Syndromes (HR-MDS) Using a United States (US) Electronic Medical Record (EMR)-Based Cohort

24,512 PPPM [SD: