PMID- 35241295 OWN - NLM STAT- MEDLINE DCOM- 20220524 LR - 20220624 IS - 1879-114X (Electronic) IS - 0149-2918 (Linking) VI - 44 IP - 4 DP - 2022 Apr TI - Burden of Illness and Treatment Patterns in Second-line Large B-cell Lymphoma. PG - 521-538 LID - S0149-2918(22)00051-0 [pii] LID - 10.1016/j.clinthera.2022.02.004 [doi] AB - PURPOSE: This study examined real-world treatment patterns with curative intent, adverse events, and health care resource utilization and costs in patients with relapsed or refractory large B-cell lymphoma (LBCL) to understand the unmet medical need in the United States. METHODS: Adult patients with >/=2 LBCL diagnoses between January 1, 2012, and March 31, 2019, were identified (index date was the date of the earliest LBCL diagnosis) from MarketScan(R) Commercial and Medicare Supplemental Databases. Patients had >/=1 claim for any LBCL treatment, >/=6 months of data before (baseline) and >/=12 months of data after (follow-up period) the index date, and no baseline LBCL diagnosis. Treatment patterns, adverse events, and all-cause and LBCL-related health care resource utilization and costs were examined. All patients had received first-line therapy of cyclophosphamide, doxorubicin, vincristine, and prednisone with or without rituximab; etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride with or without rituximab; or regimens with anthracycline and second-line therapy with stem cell transplant (SCT)-intended intensive therapy or platinum-based chemotherapy. Patients who received an SCT-intended second-line regimen or received an SCT regardless of second-line regimen were considered SCT eligible. FINDINGS: A total of 188 patients met the criteria of eligibility for SCT. Among the 119 patients who received a second-line regimen intended for SCT, only 22.7% received an SCT. Patients eligible for SCT started first-line therapy within 1 month of their LBCL index date, and the mean duration of first-line therapy was 4.1 months. The mean gap in therapy between first- and second-line therapy was 6.6 months, and the mean duration of second-line therapy was 3.0 months. During the second-line therapy treatment window (mean duration with SCT, 12.4 months; mean duration without SCT, 4.8 months), the most common regimens for patients eligible for SCT were ifosfamide, carboplatin, and etoposide with or without rituximab and gemcitabine and oxaliplatin with or without rituximab; the top 4 most common treatment-related adverse events were febrile neutropenia (56.4%), anemia (49.5%), thrombocytopenia (42.6%), and nausea and vomiting (36.2%), which were similar regardless of receipt of SCT; mean (SD) per-patient-per-month all-cause costs were $46,174 ($49,057) for patients with SCT and $45,780 ($52,813) for patients without SCT. IMPLICATIONS: Treatment patterns among patients with relapsed or refractory LBCL eligible for SCT were highly varied. Only 22.7% of patients who received an SCT-preparative regimen ultimately received SCT, which highlights the magnitude of unmet needs in this population. The occurrence of treatment-related adverse events was similar regardless of SCT status. Per-patient-per-month all-cause costs were also similar with upfront SCT costs averaged during a longer follow-up. CI - Copyright (c) 2022 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Snider, Julia Thornton AU - Snider JT AD - Kite, A Gilead Company, Santa Monica, California. FAU - McMorrow, Donna AU - McMorrow D AD - IBM Watson Health, Cambridge, Massachusetts. Electronic address: dmcmorro@us.ibm.com. FAU - Song, Xue AU - Song X AD - IBM Watson Health, Cambridge, Massachusetts. FAU - Diakun, David AU - Diakun D AD - IBM Watson Health, Cambridge, Massachusetts. FAU - Wade, Sally W AU - Wade SW AD - Wade Outcomes Research and Consulting, Salt Lake City, Utah. FAU - Cheng, Paul AU - Cheng P AD - Kite, A Gilead Company, Santa Monica, California. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220228 PL - United States TA - Clin Ther JT - Clinical therapeutics JID - 7706726 RN - 4F4X42SYQ6 (Rituximab) RN - 5J49Q6B70F (Vincristine) RN - 6PLQ3CP4P3 (Etoposide) RN - 80168379AG (Doxorubicin) RN - 8N3DW7272P (Cyclophosphamide) RN - VB0R961HZT (Prednisone) SB - IM MH - Adult MH - Aged MH - *Antineoplastic Combined Chemotherapy Protocols/adverse effects MH - Cost of Illness MH - Cyclophosphamide MH - Doxorubicin/adverse effects MH - Etoposide/therapeutic use MH - Humans MH - *Lymphoma, Large B-Cell, Diffuse/drug therapy MH - Medicare MH - Prednisone/adverse effects MH - Rituximab/therapeutic use MH - United States/epidemiology MH - Vincristine/adverse effects OTO - NOTNLM OT - health care resource utilization and costs OT - large B-cell lymphoma OT - stem cell transplant OT - treatment pattern OT - treatment-related adverse events COIS- DECLARATION OF INTEREST Drs. Snider and Cheng are employees of Kite, a Gilead Company. Ms. McMorrow, Dr. Song, and Mr. Diakun are employees of IBM Watson Health. Ms. Wade is an employee of Wade Outcomes Research and Consulting. The authors have indicated that they have no other conflicts of interest regarding the content of this article. EDAT- 2022/03/05 06:00 MHDA- 2022/05/25 06:00 CRDT- 2022/03/04 05:35 PHST- 2021/06/02 00:00 [received] PHST- 2021/11/23 00:00 [revised] PHST- 2022/02/05 00:00 [accepted] PHST- 2022/03/05 06:00 [pubmed] PHST- 2022/05/25 06:00 [medline] PHST- 2022/03/04 05:35 [entrez] AID - S0149-2918(22)00051-0 [pii] AID - 10.1016/j.clinthera.2022.02.004 [doi] PST - ppublish SO - Clin Ther. 2022 Apr;44(4):521-538. doi: 10.1016/j.clinthera.2022.02.004. Epub 2022 Feb 28.