Minority Populations With Aggressive B-Cell Lymphoma Achieved Equitable Estimated Survival Through Equal Access to Care and Nurse Navigation

A similar survival was noted among White and minority patients who had aggressive large B-cell lymphoma (LBCL), which was primarily attributed to equal access to guideline-concordant therapy and possibly navigation encounters, according to a study published in Cancer.

In patients who were a minority or White, little difference was noted in terms of prognostic scores of 3 or greater (43% vs 47%; P = .50), treatment with frontline anthracycline-based chemotherapy and rituximab (Rituxan; 98% vs 96%; P = .68), or incidence of relapsed/refractory disease (40% vs 38%; P = .74). In total, over 85% of patients received nurse navigation, with minorities notably having higher intensity encounters (42% vs 21%; P = .01). For White patients, the estimated 2-year overall survival (OS) rate were 81% and for minorities it was 76% (HR, 0.68; 95% CI, 0.34-1.35; P = .27). Additionally, the estimated 2-year progression-free survival (PFS) rates were 62% for minority patients and 65% for White patients (HR, 1.07; 95% CI, 0.66-1.74; P = .78).

“Unlike previous studies, which have shown inferior outcomes in minorities vs White [patients], this is the first study to our knowledge that shows similar survival outcomes in White and minority [patients] with aggressive LBCL. Similar prognostic risk scores between the 2 groups allowed us to compare the effect of our interventions: 1. guideline-conforming treatment options and 2. nurse navigation,” the study’s investigators wrote.

In total, 204 patients with aggressive LBCL enrolled on the study including 186 patients with diffuse large B-cell lymphoma (DLBCL), 4 with high-grade B-cell lymphoma (HGBL), and 14 patients with primary mediastinal B-cell lymphoma (PMBCL).

Investigators found that minority patients were diagnosed at a younger age compared with White patients (median age, 56 vs 62 years; P = .03). The both the minority patient population and White population consisted primarily of males (45% and 50%; P = .62). Additionally, minority patients had either Medicaid or no insurance at the time of being diagnosis compared with White patients (26% vs 4%; P < .001). Moreover, minority patients had a farther commute to treatment centers than White patients, with the latter being more likely to live within less than 20 miles of the center (62% vs 35%; P = .001).

Almost all patients had at least 1 nurse navigator encounter, with no major differences noted between the minority and White cohorts when accessing services (81% vs 87%; P = .35). Investigators observed that more minority patients experienced more high-intensity nurse navigation encounters than White patients (42% vs 21%; P = .01). Additionally, more minority patients relied on nurse navigation than White patients for assistance with compliance concerns (18% vs 7%; P = .04), insurance questions (29% vs 8%; P = .002), financial concerns (37% vs 18%; P = .02), and transportation concerns (16% vs 2%; P = .004). Moreover, high intensity encounters had an association with significantly longer total times when compared with low-intensity encounters (135 minutes vs 60 minutes; P < .001).

There was a similar proportion of patients with DLBCL, HGBL, and PMBCL across minority and White patients (P = .80). The Revised International Prognostic Index (R-IPI) was not available for 12 patients, with the missing number being comparable between groups. For minority (43%) and White patients (47%) there was no difference in the R-IPI score, and they had a score of 3 or greater (P = .50).

Additionally, investigators noted similarities among patients receiving accesses to hematopoietic stem cell transplantation (32% vs 29%; P> .99), CAR T-cell therapy (16% vs 19%; P> .99), and clinical trials (17% vs 14%; P = .64) for minorities and Whites. For either group, the median number of lines of treatment was 1 (range minority, 1-6; range White, 0-8; P = .67).

The median follow-up was 35 months with PFS and OS being comparable between the 2 groups. In minority patients, 47% of patients (n = 22) experienced progression or death events, vs 43% (n = 68) of White patients. In terms of OS, 10 deaths were reported among minority patients and 46 among White patients.

A univariate analysis of OS, patients’ age at diagnosis (HR, 1.33; 95% CI, 1.19-1.49; P < .001), driving distance of more than 20 miles (HR, 2.75; 95% CI, 1.45-5.22; P = .002), disease characteristics that included an R-IPI score of 3 or higher (HR, 2.63; 95% CI, 1.46-4.73; P = .001), the presence of relapsed/refractory disease (HR, 5.13; 95% CI, 2.74-9.61; P < .001), as well as the diagnosis of double-hit lymphoma (HR, 2.30; 95% CI, 1.15-4.60; P = .02) were associated with poorer survival, although factors such as sex or utilization of nurse navigation services.

The multivariate modeling did not identify a difference in OS between White or minority cohorts (HR, 1.20; 95% CI, 0.59-2.45; P = .62), although patient age, relapsed/refractory disease, and driving distance remained as independent predictors of prognosis.

Reference

Hu B, Boselli D, Pye LM, et al. Equal access to care and nurse navigation leads to equitable outcomes for minorities with aggressive large B-cell lymphoma. Cancer. Published online July 21, 2021. doi:10.1002/cncr.33779