Abstract IA28: Disparities in late effects incidence among adolescent and young survivors of lymphoma

Background: Survival after lymphomas, the most common malignancies in adolescents and young adults (AYAs), has improved significantly over time as a result of advances in diagnostic procedures and therapeutic management. However, studies have shown that survival varies substantially by race/ethnicity, socioeconomic status (SES), health insurance coverage, and clinical factors. Additionally, therapies that lead to cure, such as chemotherapy and radiation, can result in an elevated lifetime risk of chronic medical conditions (“late effects”) that can considerably impair the quality of life and increase mortality of survivors. We aimed to estimate the burden of late effects in AYA lymphomas survivors and identify sociodemographic and clinical factors associated with late effects incidence. Methods: We used data from the California Cancer Registry linked to hospitalization data from the California Office Statewide Health Planning and Development. Eligible patients were those diagnosed with a first primary non-Hodgkin (NHL) or Hodgkin lymphoma (HL) from 1996 to 2012 who survived at least 2 years after diagnosis. Patients were followed through 2014. The late effects included cardiovascular, respiratory, kidney, liver, endocrine, and neurologic diseases, as well as avascular necrosis and second cancers. We estimated the cumulative incidence of each condition, accounting for death as a competing risk. Cox proportional hazards regression models were used to examine the relation of sociodemographic and clinical factors to late effects, providing an estimate of the hazard ratio (HR) and associated 95% confidence intervals (CI). NHL and HL models were adjusted for age at diagnosis, year of diagnosis, stage at diagnosis, sex, race/ethnicity, cancer subtype (NHL), B-symptoms (HL), initial treatment (chemotherapy and radiation), receipt of a hematopoietic stem cell transplant (HSCT), health insurance, and neighborhood SES. Patients with human immunodeficiency virus (HIV) infection were considered separately in the NHL analyses and excluded from the HL analyses. Results: We identified 5,085 HL and 4,817 NHL survivors. Of those with NHL, 425 (9%) were HIV infected. In both HL and NHL cohorts, the highest cumulative incidence of late effects was observed for endocrine, cardiovascular, and respiratory diseases. Among NHL survivors, those with HIV infection had a higher incidence of all late effects, including an over 3-fold higher risk of second cancers compared with HIV-uni