Health Disparities and the Global Landscape of Lymphoma Care Today

The American Society of Clinical Oncology (ASCO) Annual Meeting brings together more than 30,000 oncology professionals each year to encourage discourse on leading research, state-of-the-art treatments, and ongoing controversies in the field. At this year’s Annual Meeting in Chicago, our own Dr. Adrienne Phillips was selected to present a review of the current health disparities in lymphoma care.

Adrienne Phillips

According to the National Institute on Minority Health and Health Disparities, health disparities are defined as “differences in incidence, prevalence, morbidity, mortality and burden of diseases and other adverse health conditions that exist among specific population groups.”

Dr. Phillips explained that health disparities may be due to a variety of factors, including race, gender, biology, and social and environmental differences such as socioeconomic status, health literacy, trust in the healthcare system, proximity to a healthcare facility, and access to and type of health insurance. For example, being uninsured or receiving government-assisted insurance increases patients’ risk of death by 1.5 times. Even patients’ place of residence may play a role, with treatment in rural, community-based settings being associated with inferior overall survival (OS) rates compared to treatment in urban, academic-based settings.

What Dr. Phillips and other physicians find most disconcerting about disparity in lymphoma care is that the disease is often amenable to effective therapy, but a significant segment of the population does not, or cannot, access appropriate care. For example, survival rates for some lymphomas skew lower for black people than for white people. Dr. Phillips conjectured that while African Americans tend to have poorer outcomes, the disparity is likely due to issues related to healthcare access and socioeconomic status.

According to an analysis of 701 people with diffuse large B-cell lymphoma (DLBCL) treated at two southern referral centers with a large black patient population (University of Alabama at Birmingham and Emory University in Atlanta), race did not influence outcomes. Black and white patients who received standard DLBCL chemotherapy drug combination rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) achieved similar OS rates (5y OS, 79% vs 70%).

Biological factors may also play a role in health disparities, and scientists are constantly working to better understand molecular factors in tumor development regardless of patient ethnicity.

In general, lymphoma is less common among African Americans and Asian Americans, but specific subtypes – like T-cell lymphoma in African Americans and natural killer T-cell (NKT) lymphoma in Asian Americans – are more common in these populations. Thus, Dr. Phillips highlighted a need for ethnic and racial diversity in clinical trial recruitment and in future studies of socioeconomic status and disease biology in order to better understand and improve outcomes for all patients.

New Clinical Trial: Efficacy of Autologous EBV-specific T cells for the Treatment of Patients with Aggressive Extranodal NK/T-cell Lymphoma

The Weill Cornell Lymphoma Program has recently opened a new clinical trial for men and women with extranodal NK/T-cell lymphoma. The study sponsor is Cell Medica, and the principal investigator at Weill Cornell is Dr. Jia Ruan. For more information about the study, please call Amelyn Rodgriguez, RN at (212) 746-1362 or e-mail Amelyn at amr2017@med.cornell.edu.

Key Eligibility

  • Men and women age 18 and older
  • Non-Hodgkin lymphoma called extranodal NK/T-cell lymphoma
  • Disease has not gone away with treatment, or has come back
  • Detailed eligibility reviewed when you contact the study team

Study Details

The purpose of this study is to find out more about the safety and effects of giving CMD-003 (EBV T-cells, an investigational new product) to treat participants with extranodal natural killer T-cell lymphoma (NK/T-cell lymphoma).

In this study the investigational EBV specific T-cell product is grown from the participant’s own blood.  Investigational means that it is being testing and has not been approved by Regulatory Agencies like the United States Food and Drug Administration (FDA).

Treatment Plans

There will be two phases in the study, the screening phase and the treatment phase. In the screening phase, the study doctor will need to take some of the participant’s blood and send it to a laboratory to manufacture the experimental autologous T-cell product. This manufacturing process will take about 35 days.

The treatment phase will consist of up to 5 CMD-003 T-cell doses given intravenously (into the veins) for about 10 minutes over 6 months. Participants will be seen by the study doctor at 8 regular study visits over a one year period. The study doctor will check how the cancer responds to the EBV T cell treatment with standard imaging. Some additional blood samples will be taken to check how the body is reacting to the drug.