Epidemiology Projection Trends for Non-Hodgkin Lymphoma (NHL) and Its Subtypes in the United States (US) and Europe (EU)
Authors: Trask Peter C , Mehta Jyotsna , Abbe Adeline , RuizSoto Rodrigo 
Published: October 2019

Abstract
Abstract 5074

Background
NHL is the 10th most common cancer worldwide, and a major cause of cancer-related deaths despite major advances in therapy (GLOBOCAN 2008). It encompasses a heterogeneous group of hematological malignancies originating in lymphoid tissue, mainly B lymphocytes (B-cell NHL) with an overall 5-year survival of 50–60%. There is lack of published data on the distribution of patients across lines of therapy and by subtype.

Method
Epidemiological data was obtained for US and EU using the 'epic oncology' 2012 database (Epiphany Partners Inc.). The database includes line of therapy estimations using an advanced patient flow model combining survival by subset and course of treatment, response rates and outcomes, and treatment data from U. S. and EU cancer registries coupled with primary research with a representative sample of physicians and secondary therapeutic reviews.
We analyzed projection estimates up to 2020 across US and EU5 countries by subtype and line of therapy with specific attention to relapsed/refractory patients. Refractory patients are those who do not respond (do not go into remission) following therapy. Relapsed patients are defined as those who have responded to therapy (enter remission) who then re-enter the treatment population due to progression of their cancer, recurrence of diagnostic markers, or symptomatology.

Result
Projection estimates from 2010 to 2020 by line of therapy varied by country. Among EU countries the highest number of treated patients was in Italy followed by Germany and UK. By 2020, the percentage of patients that will have relapsed and/or be refractory to all lines of therapy will increase by about 35% in US and 11% in EU with regional variation observed among France (18%), Italy (15. 2%), Spain (3%), and UK (18%). In both the US and EU, about 30% of patients relapse and 20% are refractory after 1st line treatment. In 2nd as well as 3rd line, about 35% relapse or are refractory after treatment in the respective lines. In the US, the percent increase from 2010 to 2020 by line of therapy (1st, 2nd, 3rd) is greatest for MCL patients (55, 58, 59%) followed by FL (40, 49, 41%) and DLBCL (28, 33, and 36%).
Epidemiology projection trends for US and EU by line of therapy and sub type

Conclusion
Due to the indolent or aggressive nature of NHL, the proportion of patients who will progress from 1st line to 2nd line therapy varies between 35% in US and 29% in EU based on current treatment options. This, along with the high percentage of relapsed and refractory patients in 2nd or higher lines argues for continued efforts to be made for the development of more efficacious treatments for NHL. The observed three fold difference between US and EU increase could be due to an increased incidence in recent historical years or an association between one or more of the risk factors, such as hepatitis C, which is more common in US or autoimmune disorders such as HIV. Real world data and disease based registries can help in validating emerging trends in therapy through providing up to date global projection estimates across line of therapy.

Disclosures:
Trask: Sanofi: Employment. Mehta:Sanofi: Employment. Abbe:Sanofi: Employment, Equity Ownership. RuizSoto:Sanofi: Employment.