Real world population-based study of treatment-modalities of diffuse large B-cell lymphoma in Belgium : focus on the older population

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Real-world estimation of first- and second-line treatments for diffuse large B-cell lymphoma using health insurance data : a Belgian population-based study

We determined first- and second-line regimens, including hematopoietic stem cell transplantations, in all diffuse large B cell lymphoma (DLBCL) patients aged >= 20 yr (n = 1,888), registered at the Belgian Cancer Registry (2013-2015). Treatments were inferred from reimbursed drugs, and procedures registered in national health insurance databases. This real-world population-based study allows to assess patients usually excluded from clinical trials such as those with comorbidities, other malignancies (12%), and advanced age (28% are >= 80 yr old). Our data show that the majority of older patients are still started on first-line regimens with curative intent and a substantial proportion of them benefit from this approach. First-line treatments included full R-CHOP (44%), "incomplete" (R-)CHOP (18%), other anthracycline (14%), non-anthracycline (9%), only radiotherapy (3%), and no chemo-/radiotherapy (13%), with significant variation between age groups. The 5-year overall survival (OS) of all patients was 56% with a clear influence of age (78% [20-59 yr] versus 16% [>= 85 yr]) and of the type of first-line treatments: full R-CHOP (72%), other anthracycline (58%), "incomplete" (R-)CHOP (47%), non-anthracycline (30%), only radiotherapy (30%), and no chemo-/radiotherapy (9%). Second-line therapy, presumed for refractory (7%) or relapsed disease (9%), was initiated in 252 patients (16%) and was predominantly (71%) platinum-based. The 5-year OS after second-line treatment without autologous stem cell transplantation (ASCT) was generally poor (11% in >= 70 yr versus 17% in 1 within 3 months from incidence), subsequent malignancies (HR 2.50), prior malignancies (HR 1.34), respiratory and diabetic comorbidity (HR 1.41 and 1.24), gender (HR 1.25 for males), and first-line treatment with full R-CHOP (HR 0.41) or other anthracycline-containing regimens (HR 0.72). Despite inherent limitations, patterns of care in DLBCL could be determined using an innovative approach based on Belgian health insurance data

Real world population-based exploration of the pathology subtyping and treatment-modalities of diffuse large B-cell lymphoma in Belgium in relation to survival

Background Up to now no real world data on the diagnostic work-up and treatments of diffuse large B-cell lymphoma (DLBCL) in Belgium were available. Aims To determine the patterns of care for DLBCL in Belgium with a specific focus on the elderly population, patients with comorbidities and other tumors (12%). Methods Coded data of all adult (≥ 20 year) DLBCL diagnosed 2013-2015 (n=1,890) were obtained via the Belgian Cancer Registry. Vital status was available until 1/7/2019. Data was extracted from pathology reports (10 biomarkers from IHC – FISH) and oncological care programs (performance status – staging). Treatments were inferred from health insurance data of reimbursed drugs. Information on HSCT and radiotherapy was based on nomenclature codes. An in-house algorithm was set up to define: Chemotherapy regimen (e.g. R-CHOP/R-DHAP) Number of cycles and cycle interval Switch between regimen Results Overall survival: The 2-year OS of all patients was 63.07% with a clear influence of age (30-84%). In contrast to the IPI using 60 as a cut-off, survival changed more markedly after the age of 70. Biomarkers: Pathology subtyping in 2013-2015 was missing information on now deemed essential biomarkers in 10-85% of cases. Of the evaluable cases, 49% were double expressors and 10% were double-hit DLBCL (FISH performed in only ±10%). No major differences were observed between age groups. Treatments: These varied significantly by age group and are displayed in Figure 1. Systemic treatment was started in 84%, decreasing with age to only 43%. Anthracycline based regimens were most frequently used, even in the elderly, and gold standard R-(mini)CHOP was associated with the best 4y-OS of 76%. Radiotherapy alone was frequently (5-13%) used in the elderly, and associated with a worse survival. Nonetheless the 4y-OS of 38% suggests a cure for selected patients. Second line treatments were mostly platinum based and survival without an option for autologous HSCT (ASCT) was poor (5y-OS 65% (ASCT) vs 11% (no-ASCT)). ASCT within 2 years from diagnosis was frequently performed in 1st line (n=32/67) and 3y-OS from start of ASCT in 1st, 2nd or further lines was similar (71%). Prognostic markers: Age seemed the most important prognostic factor (HR 1.94 to 5.7 for increasing age) on top of performance status (HR 3.74 if >1). Up to 12% had other malignancies with a worse prognosis (HR 2.00). Treatment with anthracycline containing regimens was associated with a better prognosis (HR 0,36 for ≥6 cycles of R-CHOP and HR 0,75 for other anthracycline containing regimens). Conclusion This real world population-based study allows to assess Belgian DLBCL patients usually excluded from clinical trials. Up to 28% of patients are ≥80 years old affecting treatment decisions and survival. The majority (63%) of older patients [70-84 yr-old] are started on anthracycline based treatments and seem to benefit from it

Completeness and selection bias of a Belgian multidisciplinary, registration-based study on the EFFectiveness and quality of Endometrial Cancer Treatment (EFFECT)

Background: With the aim of obtaining more uniformity and quality in the treatment of corpus uteri cancer in Belgium, the EFFECT project has prospectively collected detailed information on the real-world clinical care offered to 4063 Belgian women with primary corpus uteri cancer. However, as data was collected on a voluntary basis, data may be incomplete and biased. Therefore, this study aimed to assess the completeness and potential selection bias of the EFFECT database. Methods: Five databases were deterministically coupled by use of the patient’s national social security number. Participation bias was assessed by identifying characteristics associated with hospital participation in EFFECT, if any. Registration bias was assessed by identifying patient, tumor and treatment characteristics associated with patient registration by participating hospitals, if any. Uni- and multivariable logistic regression were applied. Results: EFFECT covers 56% of all Belgian women diagnosed with primary corpus uteri cancer between 2012 and 2016. These women were registered by 54% of hospitals, which submitted a median of 86% of their patients. Participation of hospitals was found to be biased: low-volume and Walloon-region centers were less likely to participate. Registration of patients by participating hospitals was found to be biased: patients with a less favorable risk profile, with missing data for several clinical-pathological risk factors, that did not undergo curative surgery, and were not discussed in a multidisciplinary tumor board were less likely to be registered. Conclusions: Due to its voluntary nature, the EFFECT database suffers from a selection bias, both in terms of the hospitals choosing to participate and the patients being included by participating institutions. This study, therefore, highlights the importance of assessing the selection bias that may be present in any study that voluntarily collects clinical data not otherwise routinely collected. Nevertheless, the EFFECT database covers detailed information on the real-world clinical care offered to 56% of all Belgian women diagnosed with corpus uteri cancer between 2012 and 2016, and may therefore act as a powerful tool for measuring and improving the quality of corpus uteri cancer care in Belgium

Providing both autologous and allogeneic hematopoietic stem cell transplants (HSCT) may have a stronger impact on the outcome of autologous HSCT in adult patients than activity levels or implementation of JACIE at Belgian transplant centres.

While performance since the introduction of the JACIE quality management system has been shown to be improved for allogeneic hematopoietic stem cell transplants (HSCT), impact on autologous-HSCT remains unclear in Europe. Our study on 2697 autologous-HSCT performed in adults in 17 Belgian centres (2007-2013) aims at comparing the adjusted 1 and 3-yr survival between the different centres & investigating the impact of 3 centre-related factors on performance (time between JACIE accreditation achievement by the centre and the considered transplant, centre activity volume and type of HSCT performed by centres: exclusively autologous vs both autologous & allogeneic). We showed a relatively homogeneous performance between Belgian centres before national completeness of JACIE implementation. The 3 centre-related factors had a significant impact on the 1-yr survival, while activity volume and type of HSCT impacted the 3-yr survival of autologous-HSCT patients in univariable analyses. Only activity volume (impact on 1-yr survival only) and type of HSCT (impact on 1 and 3-yr survivals) remained significant in multivariable analysis. This is explained by the strong relationship between these 3 variables. An extended transplantation experience, i.e., performing both auto & allo-HSCT, appears to be a newly informative quality indicator potentially conveying a multitude of underlying complex factors