Health Services & Outcome Research

Tanya Siddiqi, et al.
The authors of the study conclude: The results of this analysis show that hospital and ICU LOS are key drivers of CRS management cost and are mainly associated with managing grade 3/4 CRS. These results are based on national average costs; actual costs may vary between hospitals. The incidence of CRS and management guidelines vary across CAR T therapies and will affect both HRU and associated cost differences. CRS management is also contingent on patient characteristics. The biology of CARTs and resultant safety profile of the various products will likely drive dissimilarities in CRS management and cost.
Murielle Roussel, et al.
The authors of the study conclude: Most functional and symptom domains of HRQoL that were impaired at the time of diagnosis significantly improved during treatment with RVd in SCT-eligible pts with NDMM. This improvement in HRQoL was further increased over the subsequent treatment phases to the level of HRQoL experienced by the general population. This study complements clinical data from the IFM/DFCI 2009 trial, which demonstrated that QoL outcomes for pts could be improved by combination therapy with lenalidomide and bortezomib, thus providing additional support for the use of RVd as induction and consolidation treatment for SCT-eligible pts with NDMM. Furthermore, RVd treatment post-induction seems to improve pt QoL (relative to baseline and measured just before SCT) and could potentially be a strategy to minimize the burden associated with SCT. Further research is warranted to help understand this impact.
Karthik Ramasamy et al
The authors of the study conclude: This analysis confirms Rd to be superior to other licensed treatments currently available, in terms of both PFS and OS. Of emerging treatment options, based on current published evidence, only RVd significantly extends PFS and OS.

4731 Factors Associated with Early Therapy Initiation in Patients (pts) with Myelodysplastic Syndromes (MDS) in the Connect® MDS/AML Disease Registry

Christopher R. Cogle, et al.

The authors of the study conclude: Early first-line tx in MDS pts was significantly associated with disease severity as indicated by transfusion dependency, higher IPSS risk score, and higher BM blast percentage. However, counter to common assumptions, age, frailty, and comorbidities were not associated with receiving early tx in MDS. Access to care may be an important factor in the tx of MDS pts, as having private health insurance and undergoing genetic testing were also significantly associated with receiving early tx. Additional pt-centered research with prescribing MDS physicians as stakeholders is needed to verify and extend these findings.


4737 Survival Analysis from the CALGB Study of Lenalidomide Maintenance Therapy in Newly Diagnosed Multiple Myeloma Post-Autologous Stem Cell Transplantation Adjusted for Crossover (Alliance 100104)

Philip L. McCarthy, et al.

The authors of the study conclude: This analysis was performed on an updated version of the data set reported in the Holstein article. Once we adjusted for crossover, depending on the methodology used, there was an additional gain of ~40 months of OS. Previously, a pre-planned, pooled meta-analysis of 3 studies that included CALGB/Alliance (McCarthy PL, et al J Clin Oncol. 2017;35:3279-89) indicated that the OS gain was 2.5 years; however, our analysis from the CALGB study alone shows that LEN maintenance may provide a survival benefit of > 3 years. In diseases where prolonged follow-up is required to demonstrate survival benefits, allowing patients to crossover to active treatment may be important to facilitate this. However, the results should be analyzed appropriately to enable assessment of the value of the therapy. As this analysis indicates, the value of active treatment may be underestimated if adjustment for crossover is not performed. In conclusion, the data reported here provide further insight into the survival benefits of LEN maintenance therapy post-ASCT and support guideline recommendations to offer LEN maintenance therapy to all patients post-ASCT.

Support: U10CA180821, U10CA180882, U10CA180820; Identifier: NCT00114101.


835 Real-World Treatment Patterns and Comparative Effectiveness Among a Population of Elderly Patients with Acute Myeloid Leukemia (AML)

Bruno C. Medeiros, et al. 

The authors of the study conclude: There was a significant survival benefit for patients who received all types of antileukemic therapy, even among the HMA and Other therapy groups who had similar characteristics to the Untreated group of patients. The findings from this study provide a rationale to strongly consider therapy rather than best supportive care in older patients who do not fit the criteria for more intensive regimens.