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PROGNOSTIC IMPLICATIONS OF THE MICROENVIRONMENT IN FOLLICULAR LYMPHOMA UNDER RITUXIMAB AND RITUXIMAB+LENALIDOMIDE THERAPY. A TRANSLATIONAL STUDY OF THE SAKK35/10 TRIAL
Author(s) -
Menter T.,
Tzankov A.,
Zucca E.,
Kimby E.,
Vanazzi A.,
Østenstad B.,
Mey U.J.,
Rauch D.,
Wahlin B.,
Hitz F.,
Hernberg M.,
Johansson A.,
Nully Brown P.,
Hagberg H.,
Hawle H.,
Hayoz S.,
Dirnhofer S.
Publication year - 2019
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.107_2629
Subject(s) - rituximab , lenalidomide , follicular lymphoma , medicine , lymphoma , oncology , tumor microenvironment , cancer research , immunology , multiple myeloma , cancer
diagnosed advanced-stage Hodgkin lymphoma. A 20-year time horizon was used. Baseline probability estimates and utilities were derived from a systematic review of published studies (i.e. HD2000, Viviani, EORTC, HD15, HD18, RATHL, AHL2011, Echelon-1). A Canadian public health payer's perspective was considered and costs are presented in 2018 Canadian dollars. All costs and benefits were discounted by 1.5%. Sensitivity analyses were performed for key variables. Results: See Table 1 for results of the 20-year model. In the base-case analysis, the AHL2011 protocol was associated with both cost-savings and improved quality-adjusted outcomes over all other treatment strategies (Figure 1A). Sensitivity analyses demonstrated that the model was robust to key variables including probability of treatmentrelated mortality, probability of death from secondary malignancy, and probability of infertility secondary to BEACOPP. The threshold utility of infertility was found to be 0.71 (Figure 1B). Probabilistic sensitivity analyses (10,000 simulations) were performed (Figure 1C). For the WTP threshold of $100,000, AHL2011 was the dominant strategy 73% of the time (Figure 1D). Conclusions: The preferred treatment strategy for patients with newly diagnosed advanced-stage Hodgkin lymphoma is the AHL2011 PET-adapted regimen. This strategy maximizes life expectancy, quality-adjusted life years, and is the most cost-effective strategy, accounting for increased rates of hematologic toxicity, secondary malignancy, and infertility caused by exposure to at least 2 cycles of BEACOPP.