Diffuse large B-cell lymphoma (DLBCL), the most common lymphoma in the US, affects ~22,000 people/year and is a significant clinical problem for cancer patient-oriented research in that it is a curable disease, but one with heterogeneous outcomes. Despite >58% of patients being alive and cured at 5 years with modern chemo- immunotherapy, outcomes are significantly worse for patients who are African American (AA), uninsured, or those who have activated B-cell-like (ABC) biological subtype or a high international prognostic index score. Dr. Flowers has described patient outcomes for biological subtypes of DLBCL, identified racial and socioeconomic disparities in DLBCL, and modeled how race/ethnicity, biological, and socioeconomic factors interact to influence DLBCL survival. However, at present there is no unifying, comprehensive prognostic system that incorporates these parameters. To address the current and long-term unmet health needs of the lymphoma patient population, Drs. Flowers and Cerhan established the Lymphoma Epidemiology of Outcomes (LEO) cohort study (U01CA195568), which will support a broad research agenda aimed at identifying novel clinical, epidemiologic, host genetic, tumor, and treatment factors that significantly influence prognosis and survivorship. LEO will: 1) Recruit >12,000 newly diagnosed lymphoma patients (including 1,000 AA and 1,400 Hispanic participants and 3,700 DLBCLs); 2) Build a tissue bank with extracted tumor DNA and RNA, peripheral blood DNA, serum and plasma; 3) Annotate all cases with clinical, epidemiologic, pathology, and treatment data; 4) Prospectively follow patients to ascertain disease progression/relapse, retreatment, second cancers, survival, and patient-reported outcomes; and 5) Facilitate research projects that use this infrastructure. In addition, Dr. Flowers will utilize LEO protocols and the Georgia state SEER registry to construct a population-based cancer disparities cohort study that will: 1) examine the relationships between DLBCL genomics, ABC subtype, race, pattern of presentation, treatment and survival; 2) develop a computer micro-simulation model that incorporates these data into an online prognostic tool for DLBCL as a decision support tool for patients, clinicians, and other investigators. Dr. Flowers will build on his national leadership on the American Society Hematology Committee on Promoting Diversity, American Society Clinical Oncology Health Disparities Committee, and in clinical research mentorship programs for ASH and the Lymphoma Research Foundation and utilize these resources to recruit, train, and develop a cadre of junior faculty, hematology/oncology fellows, housestaff, and medical students in cancer patient-oriented research with a particular focus on developing minority investigators who will lead the field.

Public Health Relevance

Diffuse large B-cell lymphoma (DLBCL), the most common lymphoma, is a curable disease for some patients, but is associated with significantly worse for patients who are African American, uninsured, or have an unfavorable biological subtype or other clinical factors. Dr. Flowers has described patient outcomes for biological subtypes of DLBCL, identified disparities in DLBCL, modeled how race/ethnicity, biological, and socioeconomic factors interact to influence DLBCL survival, established the Lymphoma Epidemiology of Outcomes (LEO) cohort study to promote patient-oriented research, and led national programs for clinical research training and mentorship. He will utilize these resources and this expertise to recruit, train, and develop a cadre of junior faculty, hematology/oncology fellows, housestaff, and medical students in cancer patient-oriented research with a particular focus on developing minority investigators who will lead the field.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24CA208132-04
Application #
9701164
Study Section
Subcommittee I - Transistion to Independence (NCI)
Program Officer
Radaev, Sergey
Project Start
2016-07-01
Project End
2019-08-21
Budget Start
2019-07-01
Budget End
2019-08-21
Support Year
4
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Emory University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Allen, Pamela B; Flowers, Christopher R (2018) Balancing patient value and payer cost in hematologic malignancies: can it be done? Expert Rev Pharmacoecon Outcomes Res 18:123-126
Goldstein, Jordan S; Nastoupil, Loretta J; Han, Xuesong et al. (2018) Disparities in survival by insurance status in follicular lymphoma. Blood 132:1159-1166
Calzada, Oscar; Switchenko, Jeffrey M; Maly, Joseph J et al. (2018) Deferred treatment is a safe and viable option for selected patients with mantle cell lymphoma. Leuk Lymphoma :1-9
Rosand, Cecilia B; Valla, Kelly; Flowers, Christopher R et al. (2018) Effective management strategies for patients with marginal zone lymphoma. Future Oncol 14:1213-1222
Valla, Kelly; Flowers, Christopher R; Koff, Jean L (2018) Targeting the B cell receptor pathway in non-Hodgkin lymphoma. Expert Opin Investig Drugs 27:513-522
Chen, Qiushi; Staton, Ashley D; Ayer, Turgay et al. (2018) Exploring the potential cost-effectiveness of precision medicine treatment strategies for diffuse large B-cell lymphoma. Leuk Lymphoma 59:1700-1709
Guidot, Daniel M; Switchenko, Jeffrey M; Nastoupil, Loretta J et al. (2018) Surveillance imaging in mantle cell lymphoma in first remission lacks clinical utility. Leuk Lymphoma 59:888-895
Becnel, Melody; Flowers, Christopher R; Nastoupil, Loretta J (2017) Disparities in lymphoma on the basis of race, gender, HIV status, and sexual orientation. Ann Lymphoma 1:
Rai, Ashish; Nastoupil, Loretta J; Williams, Jessica N et al. (2017) Patterns of use and survival outcomes of positron emission tomography for initial staging in elderly follicular lymphoma patients. Leuk Lymphoma 58:1570-1580
Koff, Jean L; Flowers, Christopher R (2017) Prognostic modeling in diffuse large B-cell lymphoma in the era of immunochemotherapy: Where do we go from here? Cancer 123:3222-3225

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