Browsing by Autor "Marialejandra Torres Viera"

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Real-world outcomes of primary gastric diffuse large B cell lymphoma in Latin America: A multicenter cohort from the grupo de estudio latinoamericano de linfoproliferativos (GELL)
(Elsevier BV, 2025) Rafael Pichardo-Rodríguez; Brady Beltrán; Luis Mario Villela Martínez; Carolina Oliver; Marialejandra Torres Viera; Luis Felipe Rubalcava; Arianna Robles Rodriguez; Rosio Baena; Jose Macias Abasto; Melanie Castro-Mollo
Abstract INTRODUCTION: Primary gastric diffuse large B-cell lymphoma (PG-DLBCL) is a rare and heterogeneous entity within extranodal non-Hodgkin lymphomas. Due to its low prevalence, data on clinical characteristics, treatment patterns, and survival outcomes in real-world settings, particularly in Latin America, remain limited. This study aimed to describe the clinical features and treatment outcomes of patients with PG-DLBCL and to evaluate prognostic factors associated with overall survival (OS). METHODS: We conducted a multicenter, retrospective cohort study using data from the GELL registry (2015–2024), which includes adult patients diagnosed with primary gastric diffuse large B-cell lymphoma (PG-DLBCL) and treated at academic hematology centers across Latin America. Consecutive patients who received first-line immunochemotherapy with R-CHOP, R-miniCHOP, or similar rituximab-based anthracycline regimens were included. Patients lost to follow-up were excluded. Baseline clinical and laboratory variables were collected at diagnosis. The primary endpoint was overall survival (OS), defined as the time from diagnosis to death from any cause or last known follow-up. The secondary endpoint was event-free survival (EFS), defined as the time from diagnosis to progression, relapse, unplanned treatment change, or death. The median follow-up time was estimated using the reverse Kaplan–Meier method. Missing data (&lt;10%) were addressed via multiple imputation using Random Forest algorithms (mice R package). OS and EFS were estimated using the Kaplan–Meier method, and compared using the log-rank test. Multivariable Cox proportional hazards models were used to identify independent prognostic factors for OS and EFS. Predefined subgroup analyses were performed according to Helicobacter pylori (HP) status. RESULTS: A total of 157 patients were included. The median follow-up time was 35.5 months (Interquartile Range: 13.1–68.6) and 50 (32%) died during follow-up. The median age of 64 years and a slight male predominance (53%). Most patients had ECOG ≤1 (92%), no B symptoms (52%), and localized disease (55%). R-CHOP was the most common first-line regimen (80%), with ≥6 cycles completed in 61% of cases. Based on NCCN-IPI, 46% had high-intermediate or high-risk scores (≥3). Relapse occurred in 12%, and overall mortality was 32%, mainly due to disease progression and sepsis. Most patients received R-CHOP or equivalent first-line therapy. Radiotherapy was used in 9.5% of deceased and 12.0% of surviving patients. OS at 36 months was 70% (95% CI: 62–78. EFS at 36 months was 80% (95% CI: 73–88. In multivariable analysis, age (HR: 1.05 per year; 95% CI: 1.02–1.07; p &lt; 0.001), ECOG ≥2 (HR: 7.32; 95% CI: 3.09–17.3; p &lt; 0.001), and advanced stage (HR: 2.57; 95% CI: 1.27–5.17; p = 0.008) were independently associated with increased mortality. For EFS, older age (HR = 1.03; 95% CI: 1.00–1.06; p = 0.033), ECOG ≥2 (HR = 12.3; 95% CI: 4.23–35.9; p &lt; 0.001), and advanced stage (HR = 4.95; 95% CI: 1.62–15.2; p = 0.005) were independently associated with worse outcomes. In a subanalysis of 60 patients with known Helicobacter pylori status, HP-positive patients had significantly higher overall survival at 12 and 24 months (91.7% at both timepoints) compared to HP-negative patients (60.7% at 12 months and 56.7% at 36 months) and higher complete response rates (61% vs. 33%). Complete response was more common in HP-positive patients (46% vs. 26%). Disease progression (22% vs. 8%), relapse (2% vs. 0%), and treatment-related mortality (9% vs. 0%) were more frequent among HP-negative patients compared to those who were HP-positive. Conclusions In this Latin American cohort, PG-DLBCL patients showed favorable survival outcomes with standard immunochemotherapy. Advanced age, poor performance status, and advanced stage were independently associated with worse OS and EFS. Helicobacter pylori positivity was linked to better survival, higher complete response rates, and fewer adverse outcomes, suggesting its potential role as a favorable prognostic factor in PG-DLBCL.
Real-world treatment and outcomes of Mantle Cell Lymphoma in Latin America: A multinational cohort analysis
(Elsevier BV, 2025) Adriana Bornacelly; Marialejandra Torres Viera; Luis Mario Villela Martínez; Luis Felipe Rubalcava; Carolina Oliver; Brady Beltrán; Denisse Castro; Sally Paredes; José Luis Álvarez Macías; Bruno Samaniego
Abstract Background: Mantle cell lymphoma (MCL) is a rare, aggressive B-cell malignancy with heterogeneous clinical behavior and poor long-term outcomes. While treatment advances have significantly improved outcomes in high-income countries, little is known about how the real-world treatments and survival in LATAM. This study aims to characterize the clinical presentation, therapeutic approaches, transplantation and novel agents access, and survival outcomes in LATAM patients with MCL, and to identify country- and system-level factors contributing to variability in care. Methods This was a retrospective, multicenter cohort study conducted across 19 institutions in 8 LATAM countries between 2015 and 2024. Adult patients (≥18y) diagnosed with MCL were included when complete clinical, treatment, and outcome data were available. Variables analyzed included demographics, stage, prognostic indexes, frontline and salvage therapies, autologous stem cell transplantation (ASCT), access to targeted agents, and survival. Subgroup analyses were conducted by age (&lt;65 vs. ≥65), country, and institution type (public vs. academic/private). Primary endpoints were overall survival (OS), progression-free survival (PFS), and treatment response. Secondary endpoints included ASCT eligibility and use, access to maintenance therapy, and uptake of second-line (2L) targeted therapies. Results A total of 222 patients met the inclusion criteria. Median age was 64 years (range, 34–89), males predominance (70.4%). At diagnosis, 72.5% of patients had stage III/IV, 66% extra nodal involvement, 62.4% bone marrow infiltration, 49.8% elevated LDH, and 54.6% showed elevated β2-microglobulin. ECOG ps ≥2 was observed in 57.9% of patients. High-risk MIPI was present 47.8% overall and significantly more common in older patients (≥65y: 69.2% vs 41.8%; p=0.001). 1L therapy varied: 43.6% received cytarabine-based regimens, 25.3% Rituximab (R)-CHOP, and 20% R-Bendamustine (RB). Patients &lt;65y received more intensive therapy (69.2%), while those ≥65y received RB more often (37%). Public hospitals favored R-CHOP (41.2%), whereas academic/private centers preferred cytarabine-based regimens (50%). Watch&Wait was used in 9.9%. Among transplant-eligible patients, only 43.4% (n=51) underwent ASCT; main barrier was medical criteria (e.g., comorbidities, poor performance status, suboptimal response to 1L) (75%) rather than financial. R-maintenance (RM) therapy increased after 2018 from 53.3% to 63.4%. Only 19.4% of patients &lt;65y and 27.4% of those ≥65y received RM after 1L induction chemoimmunotherapy. Among transplanted patients, the post-ASCT RM group showed lower 3-year mortality (22.6% vs 33.3%) and improved overall survival. 2L therapy was given to 34% of patients. BTKi were used 32.1%, venetoclax 3.6%, and almost exclusively in private settings. BTKi access was markedly lower in public institutions (11.9% vs. 52.4%). Countries such as Cuba, Peru, and Bolivia reported no access to targeted therapies. Most relapsed/refractory patients received chemo-based regimens, resulting in modest outcomes. Complete response (CR), partial response (PR), and progression to 2L therapy were 31.4%, 41.4%, and 27.1%, respectively. Survival analysis included 218 patients with 81 deaths. Median follow-up was 26.8 months (range: IQR 12.0-44.9). OS at 12, 24, and 36 months was 88%, 77.4%, and 68.4%, respectively. Median OS was 80.5 months (95% CI: 60.1–106.3). PFS at 12, 24, and 36 months was 72.9%, 55.1%, and 47.9%; median PFS was 29.7 months. ASCT significantly improved survival, 3-year OS 79.9% vs. 61.3%; median OS 9.9 vs. 4.5y; HR 2.7, 95% CI: 1.43–5.13, p=0.002). Conclusions This real-world LATAM cohort reveals high-risk clinical profiles at diagnosis and disparities in access to transplant, maintenance, and novel agents. While ASCT showed a clear survival benefit, its implementation remains uneven. RM, post-ASCT and in older patients, was underused despite evidence of benefit and absence of financial barriers. Access to 2L targeted therapies remains extremely limited in public institutions and absent in several countries, impacting post-relapse outcomes. Despite these gaps, survival metrics appear comparable to international cohorts, suggesting biological or demographic resilience. These findings underscore the need for equitable access, regional treatment harmonization, and expansion of clinical trial infrastructure across LATAM.