Session: 906. Outcomes Research: Lymphoid Malignancies Excluding Plasma Cell Disorders: Poster III
Hematology Disease Topics & Pathways:
Research, Epidemiology, Clinical Practice (Health Services and Quality), Clinical Research, Health outcomes research, Technology and Procedures, Imaging
Methods: We conducted a retrospective cohort study using population-level administrative health data of all patients in Ontario, Canada, ≥18 years old with DLBCL, who received frontline rituximab-based chemoimmunotherapy followed by PET within 16 weeks of last chemotherapy from October 2009-April 2023. Primary exposure of interest was time from last chemoimmunotherapy to EOT PET, with short time to PET defined as ≤6 weeks, and long time to PET >6 weeks. Sensitivity analysis modelling time from last chemotherapy to PET continuously as restricted cubic splines was performed. Primary outcome was follow-up testing, defined as either repeat PET or tissue biopsy within 6 months of EOT PET. Time to PET and follow-up testing was modelled with cause-specific hazard models, adjusting for age, sex, income, comorbidities, year of PET, number of treatment cycles, radiotherapy, and accounting for clustering by institution. Cancer-specific survival from last chemoimmunotherapy cycle was examined by univariate and multivariable cause-specific hazard models. Difference in median 30-day costs in the 12 months post-PET scan in Canadian dollars (CAD) was estimated by quantile regression.
Results: A total of 5129 individuals with DLBCL had EOT PET scan following first-line treatment; 2982 (58%) had short time to PET (≤6 weeks), 2147 (42%) had long time to PET (>6 weeks). Patients with short time to PET were younger (mean 61.7 vs 63.7 years, standardized mean difference (SMD)=0.13), with less comorbidities (mean aggregated diagnosis groups 9.4 versus 9.8, SMD=0.13). Other characteristics were similar between groups. Overall, 1120 PETs and 1074 biopsies were performed in the 6 months following EOT PET. Patients with short time to PET had 717 repeat PETs (24 per 100 persons), 22% had ≥1 repeat PET, versus 403 PETs (18.8 per 100 persons), and 17% with ≥1 repeat PET in the long time to PET group. There were 643 biopsies (16.7% with ≥1 biopsy) versus 431 (16.2% with ≥1 biopsy), in short versus long time to PET. Short time to PET was associated with a higher risk of follow-up testing, with unadjusted hazard ratio (HR) of 1.15 (95% CI 1.03-1.29, p-value=0.014) and adjusted HR 1.13 (95% CI 1.01-1.26, p-value=0.033). Cumulative incidence of follow-up testing at 6 months was 32.4% (95% CI 30.8-34.1%) versus 28.7% (95% CI 26.8-30.6%) for short and long time to PET, respectively. Sensitivity analysis modelling time to PET continuously using restricted cubic splines showed similar results, with higher risk of follow-up testing for each week from last chemotherapy up until approximately 6 weeks, after which the risk was not significantly different from the 6-week mark. Sensitivity analysis using Fine-Gray model to account for competing risk of death showed similar results. There was no difference in cancer-specific death between short versus long time to PET in univariate (p-value=0.18) or multivariable analyses (p-value=0.85). Short time to PET was associated with $216.33 CAD (95% CI $91.03-$341.63, p-value<0.001) higher median 30-day costs compared to long time to PET. Median 30-day costs were $1549.36 versus $1332.41 CAD, respectively.
Conclusions: Short time to PET from last chemotherapy increases the risk of follow-up testing compared to long time to PET, increases healthcare costs, despite no impact on cancer-specific survival. Specifically, 6 weeks or longer appears to be the optimal time to wait from the last chemotherapy to mitigate this risk.
Disclosures: No relevant conflicts of interest to declare.