Examination of clinical outcomes in patients with autoimmune disease and diffuse large B cell lymphoma Restricted; Files Only

Koff, Jean (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/2z10wq21p?locale=en
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Abstract

Background: Severe immune dysregulation as seen in autoimmune (AI) disease is known to act as a significant risk factor for diffuse large B cell lymphoma (DLBCL), but little is known about the demographics or clinical outcomes of DLBCL that arises in the setting of AI disease.

Patients and Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed 2002-2009 linked to their Medicare claims data through 2011 to characterize presentation, treatment, and survival patterns in DLBCL patients, including those with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjögren’s syndrome (SS), and other B cell-mediated AI diseases. Kaplan-Meier curves and Cox proportional hazards models were generated to examine the effect of concurrent AI disease diagnosis on overall survival (OS) and lymphoma-related survival (LRS). Multivariable logistic regression models were employed to investigate the relationships between patient characteristics and discrete survival endpoints.

Results: Patients with DLBCL and AI disease were more commonly female, but patients with DLBCL and RA, SLE, SS, or other B cell AI diseases did not differ from other DLBCL patients in any other baseline presenting features and received similar first-line treatments. Patients with concomitant RA and DLBCL had decreased LRS compared to patients without AI disease (hazard ratio 1.52, 95% confidence interval 1.03– 2.22). There was also a trend towards decreased LRS in patients with SLE and DLBCL compared to all other groups, but this difference was not statistically significant in this cohort.

Conclusions: In this retrospective claims-based cohort of older patients with DLBCL, concomitant AI disease was uncommon and was more likely to occur in female DLBCL patients, which likely reflects the higher incidence of AI disease in women. The possibility of lower LRS for RA and SLE patients should be explored in future studies.

Table of Contents

TABLE OF CONTENTS

 

 

INTRODUCTION……………………………………………………………………….. 1

 

BACKGROUND..……………………………………………………………………….. 3

 

METHODS………………………………………………………………………............. 7

 

RESULTS……...……………………………………………………………………….. 12

 

DISCUSSION…..……………………………………………………………………..... 15

 

REFERENCES...……………………………………………………………………….. 22

 

TABLES AND FIGURES……...………...…………………………………………….. 31

 

Table 1……...……………………….………………………………………….. 31

 

Table 2……...……………………….………………………………………….. 33

 

Table 3……...……………………….………………………………………….. 34

 

Table 4……...……………………….………………………………………….. 35

 

Table 5……...……………………….………………………………………….. 37

 

Table 6……...……………………….………………………………………….. 39

 

Table 7……...……………………….………………………………………….. 41

 

Figure 1……...……………………….……………………………………...….. 43

 

Figure 2……...……………………….……………………………...………….. 44

 

Figure 3……...……………………….…………………………………...…….. 46

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