Michael McGuire

Early treatment initiation in lower-risk myelodysplastic syndromes produces an earlier and higher rate of transfusion independence

Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis resulting in refractory cytopenias. Red blood cell (RBC) transfusions can improve anemia; however, prolonged transfusion dependence (TD) is associated with increased morbidity and mortality. Disease-modifying therapy (DMT) for MDS can reduce transfusion requirements, although the optimum timing of DMT initiation is unclear. This retrospective study analyzed linked SEER registry and Medicare claims (2006-2012) to estimate the impact of DMT-initiation (azacitidine, decitabine, or lenalidomide) timing (≤ 3 vs.>3months from start of TD) on the likelihood of achieving transfusion independence (TI) among 508 TD patients with MDS. Mean time to DMT was 28days for early initiators (n=351) and 187days for late initiators (n=157). Fewer early initiators used erythropoiesis-stimulating agents before achieving TI versus late initiators (61.5% vs. 73.9%; P=0.007). In multivariate analyses, early DMT initiation predicted TI achievement (HR, 1.69; P<0.001); patients who met minimum active therapy-exposure requirements were more likely to achieve TI (HR, 2.12; P<0.001). Higher rates of TI were associated with reduced time between onset of TD and DMT initiation. Similarly, patients meeting the minimum treatment-exposure threshold had higher TI rates.

Costs of relapsed diffuse large B-cell lymphoma among Medicare patients

Abstract While health care costs can be considerable in individuals with diffuse large B-cell lymphoma (DLBCL), the degree to which health care expenditures vary following first-line treatment for non-relapsed versus relapsed DLBCL is unknown. Using 100% Medicare claims, we identified beneficiaries with DLBCL treated with first-line therapy between 1 January 2010 and 30 June 2014. We then compared health care expenditures of patients who received a second-line immunochemotherapy (relapse cohort) to those who did not begin a second-line therapy during follow-up (non-relapse cohort). After propensity score matching, the relapsed cohort incurred significantly higher health care costs (

Relationship between lenalidomide dose modification, duration of therapy, and long-term outcomes in patients with myelodysplastic syndromes

6998 vs

Treatment of Peripheral T-Cell Lymphoma in Community Settings

3314 per month; p < .001), driven by inpatient (

Disparities in First-line Treatment Initiation Among US Medicare Beneficiaries with Myelodysplastic Syndromes (MDS)

2548 vs

Rationale for Therapy Discontinuation in Patients with Lower-Risk Transfusion-Dependent Myelodysplastic Syndromes (LR-MDS)

1943 per month; p < .001) and outpatient office visit costs (

Early Treatment Initiation in Myelodysplastic Syndromes (MDS) Produces Higher Rate of and Earlier Transfusion Independence (TI)

3581 vs

Evaluating treatment patterns of relapsed acute myeloid leukemia (AML) among the elderly in the United States.

753 per month; p < .001). Our analysis confirms older adults with relapsed DLBCL incur higher medical costs and suggests improved first-line treatment would not only reduce the likelihood of relapse, but also contain health care costs.

Evaluating Treatment Patterns of Relapsed Acute Myeloid Leukemia Among the Elderly in the United States

Dose reductions or interruptions may be required to manage treatment-associated adverse events among patients with myelodysplastic syndromes (MDS) treated with lenalidomide; such modifications are recommended to sustain therapy and maximize treatment duration. The aim of this retrospective case-control study was to determine the relationship between lenalidomide dose modification (DM), duration of lenalidomide therapy (DOT), and patient outcomes in patients with MDS. Those patients with database follow-up >20months (n=305) were more likely to have received erythropoiesis-stimulating agents (ESAs) (P=0.004), had longer median DOT (P<0.001), and higher rate of DM (P<0.001) versus those with shorter follow-up (n=306). Multivariate analysis indicated that lenalidomide DM (odds ratio [OR] 1.08) and prior ESA treatment (OR 2.40) were significantly associated with longer follow-up; transfusion dependence before lenalidomide initiation was associated with a significantly shorter follow-up (OR 0.60). These data suggest that effective management of lenalidomide treatment using dose reduction and/or delay is associated with longer DOT, which can improve patient outcomes.

Who Is Receiving Novel Therapies for Relapsed/Refractory Follicular Lymphoma? a Retrospective Chart Review of Recent Real-World Practice

Micro‐Abstract Peripheral T‐cell lymphomas (PTCLs) represent a rare and heterogeneous group of malignancies that do not have consensus treatment recommendations. This retrospective review of 93 patients treated in community settings demonstrated considerable variability in treatment strategies. First‐line CHOP and CHOP‐like regimens were used in 74% of patients, providing 4‐year overall survival outcomes of 34% in patients without transplant consolidation and 77% with transplantation. Background: Peripheral T‐cell lymphomas (PTCLs) represent a rare and heterogeneous group of malignancies that do not have consensus treatment recommendations. Strategies extrapolated from B‐cell lymphoma have met with limited efficacy, although T‐cell–specific salvage therapies have been recently developed. Methods: To determine treatment patterns and associated outcomes in PTCL not otherwise specified (PTCL‐NOS), anaplastic large T‐cell lymphoma (ALCL), and angioimmunoblastic T‐cell lymphoma (AITL), a retrospective analysis was undertaken at a large US community oncology network among patients treated between January 2010 and April 2015. Results: Among 93 patients (44 PTCL‐NOS, 30 ALCL, 19 AITL), 23 unique treatments were used in 66 first‐line patients and 12 unique second‐line treatments were used in 24 relapsed/refractory patients. First‐line CHOP and CHOP‐like regimens were used in 74% of patients, providing 4‐year overall survival (OS) outcomes of 34% (95% confidence interval [CI], 14%‐83%) in patients without transplant consolidation (82% in ALCL, 37% in PTCL‐NOS, and 0% in AITL). Upfront stem cell transplantation trended toward improved 4‐year progression‐free survival 77% (95% CI, 54%‐100%) versus 34% (95% CI, 14%‐80%); (P = .08; hazard ratio [HR] 0.29) with 4‐year OS 77% (95% CI, 54%‐100%) versus 34% (P = .22; HR 0.41). Brentuximab was the most common second‐line therapy, with multiple additional regimens used in sequence (up to 5 salvage regimens) in many. Conclusions: The significant variability in treatments used for PTCL emphasizes the lack of consensus therapy in this rarer lymphoma and calls for additional organized prospective and registry studies to evaluate comparative effectiveness.