-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

2395 Lymphoma-Related Quality of Life (QOL) Is Not Impacted By Initial Treatment Choice in Patients with Marginal Zone Lymphoma (MZL): Results from the Prospective Lymphoma Epidemiology of Outcomes (LEO) Cohort

Program: Oral and Poster Abstracts
Session: 905. Outcomes Research – Lymphoid Malignancies: Poster I
Hematology Disease Topics & Pathways:
Research, Lymphomas, Clinical Research, patient-reported outcomes, Diseases, indolent lymphoma, real-world evidence, Lymphoid Malignancies, survivorship
Saturday, December 9, 2023, 5:30 PM-7:30 PM

Côme Bommier, MD, MSc1,2*, Mazie Tsang, MD3, Brie N. Noble, MS4*, Carrie Thompson, MD, MS5, Carla Casulo, MD6, Michelle Hildebrandt, PhD7, Allison C. Rosenthal, DO8, Eric Mou, MD9*, Urshila Durani, MD, MPH5, Annalynn M Williams, PhD, MS10, Kathleen Yost, PhD11*, Melissa C. Larson, MS1*, Brianna Gysbers12*, Matthew J. Maurer, DSc13, Andrew L. Feldman, MD14, David L Jaye, MD15, Peter Martin, MD16, Jonathon B. Cohen, MD, MS17, Dai Chihara, MD, PhD18, Izidore S. Lossos, MD19, Christopher Strouse, MD20, Brad S. Kahl, MD21, Thomas M. Habermann, MD5, Christopher R. Flowers, MD, MS18, Amylou Constance Dueck, PhD4 and James R. Cerhan, MD, PhD13

1Division of Epidemiology, Mayo Clinic, Rochester, MN
2Hematology/Oncology, Université Paris Cité, Hôpital Saint Louis, Inserm U1153, Paris, France
3Mayo Clinic, Phoenix, AZ
4Mayo Clinic, Scottsdale, AZ
5Division of Hematology, Mayo Clinic, Rochester, MN
6Wilmot Cancer Center, University of Rochester, Rochester, NY
7The University of Texas MD Anderson Cancer Center, Houston, TX
8Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
9Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
10University of Rochester, Rochester, NY
11Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
12Department of Health Sciences Research, Mayo Clinic, Rochester, MN
13Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
14Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN
15Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
16Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
17Winship Cancer Institute, Emory University, Atlanta, GA
18Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
19Sylvester Comprehensive Cancer Center, Division of Hematology, University of Miami School of Medicine, Miami, FL
20Division of Hematology, Oncology and Blood & Marrow Transplantation, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA
21School of Medicine, Washington University in St. Louis, St Louis, MO

Background: QOL can be affected by disease burden, side effects of treatment, and psychosocial effects of living with cancer. Although MZL is considered incurable, we previously found that patients diagnosed from 2002-2015 had a good QOL both at baseline (BL) and the first decade after diagnosis, regardless of treatment choice (Bommier et al., submitted). Here, we evaluate whether these findings can be extended to the 2015-2020 treatment era and a more diverse US cohort.

Methods: Adults with newly diagnosed MZL from 8 academic centers were prospectively enrolled within 6 months of diagnosis from 2015-2020 in the LEO cohort (NCT02736357). Participants were actively followed for disease progression/relapse, retreatment and death. QOL was measured at BL, and at 1, 2, 3 and 5 years after diagnosis using the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) scale (range 0-164), which consists of the FACT-General (FACT-G, range 0-104) plus a lymphoma-specific scale (range 0-60). Total FACT-G measures 4 QOL domains (range): physical (0-28), social/family (0-28), emotional (0-24), and functional (0-28) well-being (WB). We also used the Trial Outcome Index (TOI; range 0-112), which consists of FACT-G physical and functional WB plus the lymphoma-specific scale and is commonly used as an endpoint in treatment trials. All MZL patients with both BL and at least one follow-up QOL questionnaire were eligible for analysis. Patients were grouped by initial management: active surveillance (observation), local/antibiotic therapy (radiation, surgery, or anti-H. pylori therapy), or systemic therapy (chemotherapy, targeted agents, or antibody therapy). Change in QOL scores over time was analyzed using mixed models for repeated measurements, and initial treatment groups were compared.

Results: Of 384 patients, 60% were female, 91% were White, 6.6% were Black/African American, and 13% were Hispanic (all races). The median age was 64 years (range 19-94). For initial management, 28% (N=106) were observed, 31% (N=118) received local/antibiotic therapy, and 42% (N=160) received systemic therapy. Across treatment groups, there were no significant differences by age, gender, race, or performance status, while there were differences by Hispanic ethnicity (p=0.006), Ann Arbor stage (p<0.001) and MALT-IPI score (p<0.001) (Table).

At BL, patients receiving systemic therapy had lower physical WB (p=0.008), emotional WB (p=0.04), functional WB (p=0.03), FACT-G total score (p=0.008), lymphoma subscale (p<0.001), FACT-Lym (p=0.001) and TOI (p<0.001) compared to observation and local/antibiotic therapy (Table). While FACT-G total scores were largely stable through 5 years after diagnosis, social/family WB declined from BL for patients initially receiving either local/antibiotic therapy (mean at 1-year -1.4, p<0.05; 2-year -2.1, p<0.05; 3-year -1.6, p<0.05; 5-year-2.9, p<0.05) or systemic therapy (mean at 2-year -1.2 , p<0.05; 3-year -1.4, p<0.05; and 5-year -1.2, p<0.05), while this was stable for observed patients. In patients receiving initial systemic therapy, there was a transient improvement in the lymphoma-specific scale (mean +1.7, p<0.05) and TOI (mean +3.7, p<0.05). Otherwise, QOL remained stable over time and global QoL (FACT-G, FACT-Lym), TOI, Lymphoma-specific scale (Figure), and the other FACT-G subscales (physical, emotional, or functional WB) did not differ by initial treatment strategy.

Conclusions: In the diverse LEO cohort from the recent treatment era, we confirm our prior findings for newly diagnosed MZL patients that QOL is globally stable over the first 5 years after diagnosis; emotional WB is not associated with initial treatment type, providing evidence that being initially observed does not negatively impact emotional health; and there is a decline in social/family WB (support from friends and family, family acceptance of illness, family communication, close to partner), which supports the need to consider interventions for patients to address these unmet needs. In addition, this study extends these findings to the lymphoma-specific scale, FACT-Lym, and TOI, which all showing largely stable trends in the 5 years after diagnosis and suggest that recent MZL treatment strategies, including systemic therapies, neither impair nor improve QOL.

Disclosures: Bommier: LYSA/ELI: Research Funding; Philippe Foundation: Other: Mobility funding; Institut Servier: Research Funding; ITMO/AvieSan: Research Funding; INSERM: Current Employment. Tsang: Poseida Therapeutics: Current holder of stock options in a privately-held company; Novartis: Consultancy. Casulo: Abbvie: Consultancy; Lymphoma Research Foundation: Other: Leadership Role; Follicular Lymphoma Foundation: Other: Leadership role; GenMab: Research Funding; Gilead Sciences: Research Funding; Verastem: Research Funding; Bristol Myers Squibb: Consultancy, Research Funding; SecuraBio: Research Funding; Genentech: Consultancy, Research Funding. Maurer: Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Research Funding; GenMab: Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche/Genentech: Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees. Martin: AbbVie, AstraZeneca, Beigene, Epizyme, Genentech, Gilead, Janssen, Pepromene, Daiichi Sankyo: Consultancy. Cohen: BMS/Celgene: Research Funding; Novartis: Research Funding; Genentech: Research Funding; BioInvent: Research Funding; Lam Therapeutics: Research Funding; Takeda,: Research Funding; ADCT: Consultancy; AstraZeneca: Consultancy, Research Funding; Abbvie: Consultancy; Janssen: Consultancy; BeiGene: Consultancy; Loxo/Lilly: Consultancy, Research Funding. Lossos: University of Miami: Current Employment; NCI: Research Funding; Adaptive: Honoraria; LRF: Membership on an entity's Board of Directors or advisory committees; NCI: Research Funding; BeiGene: Consultancy. Kahl: Genmab: Consultancy, Honoraria; BeiGene: Consultancy, Honoraria, Research Funding; ADCT: Consultancy, Honoraria, Research Funding; Genentech: Consultancy, Honoraria, Research Funding; BMS: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Astra Zeneca: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Lilly: Consultancy, Honoraria. Habermann: BMS: Research Funding; sorrento: Research Funding; Genentech: Research Funding. Flowers: Kite: Research Funding; V Foundation: Research Funding; 4D: Research Funding; National Cancer Institute: Research Funding; Novartis: Research Funding; Nektar: Research Funding; Cellectis: Research Funding; Jannsen Pharmaceuticals: Research Funding; Morphosys: Research Funding; Adaptimmune: Research Funding; Amgen: Research Funding; Sanofi: Research Funding; Foresight Diagnostics: Consultancy, Current holder of stock options in a privately-held company; Pharmacyclics: Research Funding; Pfizer: Research Funding; Burroghs Wellcome Fund: Research Funding; Ziopharm: Research Funding; Iovance: Research Funding; Guardant: Research Funding; Takeda: Research Funding; Xencor: Research Funding; Spectrum: Consultancy; Acerta: Research Funding; Allogene: Research Funding; TG Therapeutics: Research Funding; Genentech Roche: Consultancy, Research Funding; Eastern Cooperative Oncology Group: Research Funding; SeaGen: Consultancy; Pharmacyclics Jansen: Consultancy; N-Power Medicine: Consultancy, Current holder of stock options in a privately-held company; Genmab: Consultancy; Karyopharm: Consultancy; Gilead: Consultancy, Research Funding; Denovo Biopharma: Consultancy; Celgene: Consultancy, Research Funding; Beigene: Consultancy; Bayer: Consultancy, Research Funding; Abbvie: Consultancy, Research Funding; Cancer Prevention and Research Institute of Texas: Research Funding; CPRIT Scholar in Cancer Research: Research Funding. Cerhan: Protagonist: Other: Safety Monitoring Committee; NanoString: Research Funding; Genmab: Research Funding; BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding; Genentech: Research Funding.

*signifies non-member of ASH