ASSOCIATION OF COVID‐19 PANDEMIC WITH INDOLENT LYMPHOMA CARE DELIVERY AND OUTCOMES IN ONTARIO, CANADA: A POPULATION‐BASED ANALYSIS
Bibliographic record
Abstract
Background: Due to concern for infection risk, the coronavirus disease 2019 (COVID-19) pandemic presented a unique challenge for optimal management of indolent non-Hodgkin lymphoma (iNHL). We examined treatment (trt) selection, healthcare utilization, and COVID-19 outcomes of pts with iNHL receiving first-line (1L) systemic treatment during pre-pandemic vs. pandemic period. Methods: We performed a retrospective cohort study using administrative databases in Ontario, Canada, comparing outcomes in pts with iNHL who initiated trt from January 1, 2015 to December 31, 2018 (pre-pandemic cohort) and September 1, 2019 to August 1, 2020 (pandemic cohort), with end of follow-up March 31 2022. The primary outcome was trt pattern (e.g., 1L regimen, rituximab [R] maintenance use); secondary outcomes were death, toxicities, healthcare utilization (emergency department visit [ED], hospitalization), SARS-CoV-2 outcomes (infection, ED visit, hospitalization/death). Adjusted hazard ratios (aHR) from cause-specific proportional hazards models were used to estimate associations between factors and outcomes. Results: We identified 4,143 pts (1,079 pandemic, 3,064 pre-pandemic), median age 69 yrs, 44% female. In both pre- and pandemic periods, bendamustine (B)+R was the most frequent prescribed regimen, with no difference in number of cycles or delays (Table). During the pandemic, fewer pts received R maintenance and completed the full course (aHR 0.81, 95% confidence interval [CI] 0.71–0.92, p = 0.0010). Pts treated during the pandemic had less healthcare utilization (ED visit aHR 0.77, 95% CI 0.68, 0.88, p < 0.0001; hospitalization aHR 0.81, 95% CI 0.70–0.94, p = 0.0067) and trt-related complications (infection aHR 0.69, 95% CI 0.57–0.82, p < 0.0001; febrile neutropenia aHR 0.66, 95% CI 0.47–0.94, p = 0.020), with no difference in death (aHR 0.79, 95% CI 0.58–1.08, p = 0.14). R use (first dose to 1 yr post last dose) was associated with higher risk of SARS-CoV-2 infection (aHR 1.56, 95% CI 1.09–2.24, p = 0.015) and COVID-19 complications (ED visit aHR 4.28, 95% CI 1.79–10.26, p = 0.0011; hospitalization/death 1.81, 95% CI 1.11–2.93, p = 0.016). Conclusion: During the pandemic, BR remained the preferred regimen for iNHL trt, while R maintenance use was less. Despite the similar 1L regimen, healthcare utilization and infectious complications were less in the pandemic cohort. R use was associated with nearly 2-fold risk of COVID-19 hospitalization/death. Encore Abstract - previously submitted to ASCO 2021 Conflict of interest: A. Prica Honoraria: Astra-Zeneca, Abbvie and Kite Gilead M. Crump Consultant or advisory role: Novartis and Kyte-Gilead
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".