PMID- 33691276
OWN - NLM
STAT- MEDLINE
DCOM- 20220321
LR  - 20220321
IS  - 1540-1413 (Electronic)
IS  - 1540-1405 (Linking)
VI  - 19
IP  - 6
DP  - 2021 Mar 10
TI  - Shorter Diagnosis-to-Treatment Interval in Diffuse Large B-Cell Lymphoma is 
      Associated With Inferior Overall Survival in a Large, Population-Based Registry.
PG  - 719-725
LID - jnccn20314 [pii]
LID - 10.6004/jnccn.2020.7654 [doi]
AB  - BACKGROUND: Because of prolonged screening requirements, patient and 
      time-dependent selection have been proposed as potential biases in clinical 
      trials. The screening process may exclude patients with a need for emergent 
      treatment (and a short period from diagnosis to treatment initiation [DTI]). We 
      explored the impact of DTI on overall survival (OS) in a population-based cohort 
      of patients with diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS: 
      Using population-based administrative databases in Ontario, Canada, we identified 
      adults aged >/=18 years with DLBCL treated with rituximab-based chemotherapy for 
      curative intent between January 2005 and December 2015. Cox regression and 
      multivariable analyses were presented to evaluate the impact of time from DTI on 
      OS, controlling for relevant covariates. RESULTS: We identified 9,441 patients 
      with DLBCL in Ontario; median age was 66 years, 53.6% were male, median number of 
      comorbidities (Johns Hopkins aggregated diagnosis groups) was 10 (interquartile 
      range [IQR], 8-13), and median DTI was 37 days (IQR, 22-61). Between treatment 
      initiation and study end, 43% of patients died (median OS, 1 year; IQR, 0.4-2.8 
      years). Shorter DTI was a significant predictor of mortality (P<.001). Compared 
      with the shortest DTI period of 0-18 days, those who commenced therapy at 19-29 
      days (hazard ratio [HR], 0.75; 95% CI, 0.68-0.84), 30-41 days (HR, 0.70; 95% CI, 
      0.63-0.78), 42-57 days (HR, 0.52; 95% CI, 0.46-0.58), and 58-180 days (HR, 0.52; 
      95% CI, 0.47-0.58) had improved survival. Increasing age (HR, 1.03; 95% CI, 
      1.03-1.04), male sex (HR, 1.23; 95% CI, 1.14-1.32), and increasing number of 
      comorbidities (HR, 1.12; 95% CI, 1.11-1.13) were associated with inferior 
      survival. CONCLUSIONS: Among patients with DLBCL, shorter DTI was associated with 
      inferior OS. Therefore, DTI may represent a surrogate marker for aggressive 
      biology. Clinical trials with lengthy screening periods are likely creating a 
      time-dependent patient selection bias.
FAU - Blunt, Danielle N
AU  - Blunt DN
AD  - 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, 
      Canada.
AD  - 2Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, 
      Australia.
FAU - Smyth, Liam
AU  - Smyth L
AUID- ORCID: 0000-0002-2219-5780
AD  - 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, 
      Canada.
AD  - 3Department of Haematology, St. Vincent's University Hospital, Dublin, Ireland; 
      and.
FAU - Nagamuthu, Chenthila
AU  - Nagamuthu C
AUID- ORCID: 0000-0003-1114-1645
AD  - 4ICES, and.
FAU - Gatov, Evgenia
AU  - Gatov E
AD  - 4ICES, and.
FAU - Croxford, Ruth
AU  - Croxford R
AUID- ORCID: 0000-0002-6738-0402
AD  - 4ICES, and.
FAU - Mozessohn, Lee
AU  - Mozessohn L
AD  - 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, 
      Canada.
FAU - Cheung, Matthew C
AU  - Cheung MC
AUID- ORCID: 0000-0003-3193-5872
AD  - 1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, 
      Canada.
AD  - 4ICES, and.
AD  - 5Division of Hematology/Medical Oncology, Department of Medicine, University of 
      Toronto, Toronto, Ontario, Canada.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210310
PL  - United States
TA  - J Natl Compr Canc Netw
JT  - Journal of the National Comprehensive Cancer Network : JNCCN
JID - 101162515
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
MH  - Humans
MH  - *Lymphoma, Large B-Cell, Diffuse/diagnosis/drug therapy/epidemiology
MH  - Male
MH  - Ontario/epidemiology
MH  - Prognosis
MH  - Registries
MH  - Retrospective Studies
MH  - Rituximab/therapeutic use
EDAT- 2021/03/11 06:00
MHDA- 2022/03/22 06:00
CRDT- 2021/03/10 20:16
PHST- 2020/06/18 00:00 [received]
PHST- 2020/09/15 00:00 [accepted]
PHST- 2021/03/11 06:00 [pubmed]
PHST- 2022/03/22 06:00 [medline]
PHST- 2021/03/10 20:16 [entrez]
AID - jnccn20314 [pii]
AID - 10.6004/jnccn.2020.7654 [doi]
PST - epublish
SO  - J Natl Compr Canc Netw. 2021 Mar 10;19(6):719-725. doi: 10.6004/jnccn.2020.7654.