Sandra Eloranta

Karolinska Institutet | KI · Department of Medicine – Clinical Epidemiology Unit

Background: Descriptive data on late effects associated with castrate-resistant prostate cancer (CRPC) are sparse. We aimed to define the timing and incidence of cardiovascular disease (CVD), fractures, and diabetes in a patient population with CRPC. Methods: In the population-based STHLM0 cohort 1464 men with CRPC were identified and matched wi...

Background The increasing amount of molecular data and knowledge about genomic alterations from next-generation sequencing processes together allow for a greater understanding of individual patients, thereby advancing precision medicine. Molecular tumour boards feature multidisciplinary teams of clinical experts who meet to discuss complex individu...

Background: Achieving lasting remission for at least 2 years is a good indicator for favourable prognosis long term after Diffuse large B-cell lymphoma (DLBCL). The aim of this study was to provide real-world probabilities, useful in risk communication and clinical decision-making, of the chance for lasting remissions by clinical characteristics....

First-line treatments for lymphomas often include high doses of prednisolone, but the risks of new-onset diabetes mellitus (DM) or worsening of pre-existing DM following treatment with cyclic high dose corticosteroids is unknown. This cohort study matched non-Hodgkin lymphoma (NHL) patients treated with steroid-containing immunochemotherapy, i.e. R...

Background: Overall, women have better cancer-specific survival than men following haematological malignancies. The effect of reproductive factors on prognosis in women remains unknown and population-based studies are needed. Material and methods: A nationwide cohort of 21,237 Swedish women with a recorded haematological malignancy at ages 18-69...

Several recently published trials investigate novel therapies for relapsed/refractory diffuse large B‐cell lymphoma (R/R DLBCL). To estimate the benefit of these therapies in the real‐world setting, comprehensive data on patients treated in clinical routine are needed. We report outcomes for 736 R/R DLBCL patients identified among all curatively tr...

For most patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL), R-CHOP immunochemotherapy leads to complete remission and 60–70% of patients remain progression-free after 5 years. Given a median age of 65, it is relevant to disentangle how DLBCL and DLBCL therapy influence health care use among the survivors. In this nationwide study,...

Considering treatment changes and an improved prognosis of non-Hodgkin lymphoma (NHL) over time, knowledge regarding long-term health outcomes including late effects of treatment have become increasingly important. We report on time trends of second primary malignancies (SPM) in Swedish NHL patients, encompassing the years before as well as after t...

Introduction Central nervous system relapse (secondary central nervous system lymphoma -SCNS) is an uncommon but devastating complication of aggressive B-cell lymphoma. Patients (Pts) with CNS-IPI 4-6 are at greatest risk (10.2% at 2 years). Intravenous high-dose methotrexate (HD-MTX) is widely used to mitigate SCNS risk but data supporting this pr...

Introduction Prednisolone has important potential side-effects, one of which is steroid-induced diabetes mellitus (DM). Due to the exposure to a high cumulative dosage of steroids during first-line treatment, patients with non-Hodgkin lymphoma (NHL) could face increased risk of new onset steroid-induced DM or dysregulation of a pre-existing DM. Thi...

Statin use has been associated with reduced mortality from several cancers but also suggested, in vitro, to diminish the effectiveness of lymphoma treatments including rituximab. The present study aimed to assess the association of statin use with mortality in patients with non‐Hodgkin lymphoma (NHL) and chronic lymphocytic leukaemia (CLL). We iden...

PURPOSE The majority of young adults with Hodgkin lymphoma (HL) are cured, but chemotherapy-induced infertility can have profound psychosocial consequences. Providing data on parenthood rates and use of assisted reproductive techniques (ARTs) after contemporary HL treatment is important for patient counseling and survivorship care. MATERIALS AND M...

Background Studies describing treatment utilization for castration-resistant prostate cancer (CRPC) are limited. We aimed to describe the treatment utilization of a contemporary population-based CRPC cohort between 2006 and 2016. Methods We identified 1699 men with a PC diagnosis between 2005 and 2015, who developed CRPC between 2006 and 2015 in t...

Background The outcome for diffuse large B‐cell lymphoma (DLBCL) patients has improved with the immunochemotherapy combination R‐CHOP. An increased rate of heart failure is well documented following this treatment, whereas incidence and outcome of other cardiac complications, for example myocardial infarction, are less well known. Method We identi...

It is unknown how many mantle cell lymphoma (MCL) patients undergo consolidation with autologous hematopoietic cell transplantation (AHCT), and the reasons governing the decision, are also unknown. The prognostic impact of omitting AHCT is also understudied. We identified all MCL patients diagnosed from 2000 to 2014, aged 18 to 65 years, in the Swe...

As cancer patient survival improves, late effects from treatment are becoming the next clinical challenge. Chemotherapy and radiotherapy, for example, potentially increase the risk of both morbidity and mortality from second malignancies and cardiovascular disease. To provide clinically relevant population-level measures of late effects, it is of i...

Infections are a common complication in patients with many hematologic malignancies, however, whether patients with myeloproliferative neoplasms (MPN) also are at an increased risk of infections is largely unknown. To assess the risk of serious infections, we performed a large population-based matched cohort study in Sweden including 8 363 MPN pati...

We performed a national population-based study of all patients diagnosed with diffuse large B-cell lymphoma (DLBCL) in Sweden in 2007–2014 to assess treatment intent and risk of relapsed/refractory disease, including central nervous system (CNS) relapse, in the presence of competing risks. Overall, 84% of patients started treatment with curative in...

As cancer patient survival improves, late effects from treatment are becoming the next clinical challenge. Chemotherapy and radiotherapy, for example, potentially increase the risk of both morbidity and mortality from second malignancies and cardiovascular disease. To provide clinically relevant population-level measures of late effects, it is of i...

There is a lack of data regarding treatment and prognosis for the growing group of oldest old patients with lymphoma. Therefore, we studied 2347 patients aged ≥85 years from the Danish and Swedish lymphoma registers 2000–2016 (Denmark) and 2007–2013 (Sweden). Outcome was assessed using relative survival (RS). The 2‐year RS overall for patients with...

Question: What are the long-term reproductive outcomes after breast cancer in women with vs without a history of fertility preservation? Findings: In this population-based nationwide cohort study of 425 Swedish women with breast cancer who underwent fertility preservation, fertility preservation at the time of breast cancer diagnosis was associate...

Background Today, even though most patients with diffuse large B-cell lymphoma (DLBCL) can be cured with standard immunochemotherapy, 20-30% are refractory to primary therapy or relapse during follow-up with a drastic worsening of the prognosis. In recent years, new promising treatment options including CAR-T cell therapy are becoming available for...

Background: Kidney transplant recipients (KTRs) have an increased cancer risk compared to the general population, but absolute risks that better reflect the clinical impact of cancer are seldom estimated. Methods: All KTRs in Sweden, Norway, Denmark and Finland, with a first transplantation between 1995-2011, were identified through national reg...

Objectives: To investigate concordance in survival time among first-degree relatives with lymphoid malignancies. Methods: By linkage of national Swedish registers, we identified 66,430 patients diagnosed with a lymphoid malignancy 1958-2016 with information on first-degree relationships and follow-up until 2017. Among these, we identified pairs...

Monitoring survival of cancer patients using data collected by population‐based cancer registries is an important component of cancer control. In this setting, patient survival is often summarized using net survival, that is survival from cancer if there were no other possible causes of death. Although net survival is the gold standard for comparin...

Purpose: Patients with diffuse large B-cell lymphoma (DLBCL) who fail to complete planned treatment with R-CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (6 cycles or more, or 3 cycles + RT for patients with stage I disease) with R-CHOP for reasons unrelated to non-response, the determinant...

Statin use has been associated with reduced cancer‐specific mortality among patients with several cancer types, including multiple myeloma (MM). We aimed to further elucidate the association of statin use and dose intensity with MM survival. Using Swedish population‐based national health registers, we identified all incident MM diagnoses occurring...

Background: This study investigated prostate cancer (PC)-specific survival and overall survival (OS) in a population-based castration-resistant PC (CRPC) cohort. Methods: Data from Stockholm Prostate-Specific Antigen (PSA) and Biopsy Register patients with increasing PSA despite gonadotropin-releasing hormone treatment or surgical castration (n = 1...

Non-Hodgkin lymphoma (NHL) prognosis has improved in recent years, yet the number of patients living with the diagnosis, i.e. the prevalence, has seldom been reported. The prevalence provides a measure of the burden of disease, useful for healthcare planning and to optimise resource allocation. We provide a systematic presentation of temporal trend...

Objectives: A family history of colorectal cancer (CRC) is an established risk factor for developing CRC while the impact of family history on prognosis is unclear. The present study assessed the association between family history and prognosis and, based on current evidence, explored whether this association was modified by age at diagnosis. Met...

Background Our knowledge of the outcome of patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) in the rituximab era is mostly derived from randomised controlled trials or specialized center cohorts presenting selected patient materials. With new targeted therapies being evaluated in the relapsed/refractory setting such as CA...

Introduction: The vast majority of young adults with Hodgkin lymphoma (HL) are cured by contemporary first line treatments. Treatment-related long-term toxicities can have a negative impact on survivorship and the risk of infertility may be particularly pertinent to young HL survivors. This study aimed to investigate the fertility rate (rate of fir...

Purpose The second Nordic lymphoma group protocol for mantle cell lymphoma (NLG-MCL 2) includes three courses of maxi-CHOP alternating with three courses of high-dose cytarabine, and followed by consolidation with high-dose therapy and autologous stem-cell transplantation (ASCT). This has been the standard of care for younger MCL patients in Sweden...

Background Diffuse large B cell lymphoma (DLBCL) is an aggressive but often curable disease. However a proportion of the patients are primary refractory or relapse (R/R DLBCL) following standard immuno-chemotherapy, which is associated with a much worse prognosis especially if the CNS is involved. Current knowledge around the incidence of R/R DLBCL...

The prognosis for mantle cell lymphoma (MCL) remains poor. Our aim was to assess the impact of comorbidities on survival and causes of death. For 1,385 MCL patients (1,009 males, 376 females) diagnosed in 2000–2014 (median age 71 years, range 22–96) comorbidities ≤ 10 years of diagnosis were classified according to the Charlson comorbidity index (C...

The burden of late effects among Hodgkin lymphoma (HL) survivors treated according to contemporary protocols remains poorly characterized. We used nation-wide registers to assess number of inpatient bed-days and specialist outpatient visits among 1048 HL-patients (<25 years, diagnosed 1990-2010) and 5175 country-, sex-, and age-matched comparators....

e16555 Background: Data focusing on the castration resistant phase of prostate cancer (PC) outside clinical trial settings are scarce. This study aims to investigate PC-specific and overall survival (OS) in men with castration resistant prostate cancer (CRPC) on a population level. Methods: The STHLM-0 cohort (n = 400 000) with data on all prostate...

Solid organ transplant recipients (OTRs) have an increased cancer risk but their survival once diagnosed with cancer has seldom been assessed. We therefore investigated cancer‐specific survival among OTRs with a wide range of cancer forms nationally in Sweden. The study included 2,143 OTRs with cancer, and 946,089 non‐transplanted cancer patients d...

Purpose: Estimates of short- and long-term survival for young patients with classic Hodgkin lymphoma (cHL) are of considerable interest. We investigated cHL prognosis in the era of contemporary treatment at different milestones during the follow-up. Patients and methods: On the basis of a Nordic cohort of 2,582 patients diagnosed at ages 18 to 4...

While Hodgkin lymphoma (HL) survival has improved, treatment‐related complications remain a concern. As a measure of treatment‐related diseases of the circulatory system (DCS) we report excess incidence of DCS and absolute risks among HL patients diagnosed in the modern treatment era. From the Swedish Cancer Register, we identified all HL patients...

Purpose: Prognostic models for diffuse large B-cell lymphoma (DLBCL), such as the International Prognostic Index (IPI) are widely used in clinical practice. The models are typically developed with simplicity in mind and thus do not exploit the full potential of detailed clinical data. This study investigated whether nationwide lymphoma registries...

Purpose The prognosis for patients with mantle cell lymphoma (MCL) is rather dismal where particularly elderly patients, often with comorbidities, have difficulties tolerating the intensive treatments needed for long-term remission. Our aim was to describe the frequency and spectrum of comorbidities among patients with MCL in a population-based set...

Purpose: A few patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who start on standard primary treatment with R-CHOP do not complete the recommended 6-8 cycles for reasons related to toxicity, however, this group has seldom been formally studied. We set out to describe the outcome of DLBCL patients failing to complete at least 6 R...

Background Our knowledge around the incidence of relapse and primary refractory disease in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era is mostly derived from randomized controlled trials or specialized center cohorts presenting selected patient materials. With new therapies being evaluated and launched at diagnosis as w...

Estimates describing the survival and relapse risk for young classical Hodgkin lymphoma (cHL) patients are of considerable interest. A recent population-based study from British Columbia focused on the evolution of the relative survival and relapse risk given that patients reached certain milestones such as two years of relapse-free survival (Hapgo...

Background Results from previous studies indicate that use of low-dose aspirin may improve breast cancer prognosis. We evaluated aspirin use and breast cancer outcomes in relation to clinical characteristics as well as dose and duration of aspirin use. Methods We used information from the Regional Breast Cancer Quality-of-Care Registries in three...

Background Comorbidity impacts overall survival among patients with diffuse large B‐cell lymphoma (DLBCL). However, associations of comorbidity with lymphoma characteristics, treatment selection and lymphoma‐specific mortality are less well known. Objective To examine the impact of comorbidity on DLBCL characteristics, treatment intent and cause o...

Purpose With excellent cure rates for young patients with Hodgkin lymphoma (HL), there is an increasing number of female survivors of HL interested in becoming pregnant. Here, we report childbearing among contemporarily treated HL survivors in comparison with the general population. Material and Methods Using Swedish registers, 449 women (ages 18...

Survival has improved among patients with diffuse large B‐cell lymphoma (DLBCL) with the addition of anti‐CD20 antibody therapy. We aimed to quantify trends and remaining loss in expectation of life (LEL) due to DLBCL at a national population‐based level. Patients diagnosed with DLBCL 2000‐2013 (N=7114) were identified through the Swedish Lymphoma...

Aim: A population-based cohort and four randomized trials enriched with long-term register data were used to clarify if radiotherapy in combination with rectal cancer surgery is associated with increased risks of cardiovascular disease (CVD). Methods: We identified 14,901 rectal cancer patients diagnosed 1995-2009 in Swedish nationwide registers...

The international prognostic index (IPI) and similar models form the cornerstone of clinical assessment in newly diagnosed diffuse large B-cell lymphoma (DLBCL). While being simple and convenient to use, their inadequate use of the available clinical data is a major weakness. In this study, we compared performance of the International Prognostic In...

Figure S1. Flowchart describing the inclussion criteria.

PurposeThe benefit of whole brain radiotherapy (WBRT) for late stage breast cancer patients with brain metastases has been questioned. In this study we evaluated survival and level of care (hospital or home) following WBRT in a population-based cohort by personal and tumor characteristics. Methods We identified 241 consecutive patients with breast...

High parental age at childbirth has repeatedly been linked to childhood malignancies, while few studies have focused on the offspring’s risk of adult cancer. In this population-based case-control study, we identified 32,000 patients with lymphoid neoplasms, diagnosed at ages 0–79 years during the period 1987–2011, and 160,000 matched controls in Sw...

Background: Hodgkin lymphoma (HL) treatment protocols for children, adolescents and young adults traditionally differ, but the biological and clinical justification for this remains uncertain. Material and methods: We compared age-dependent clinical presentation and treatment and outcome for 1072 classical HL patients 0–24 years diagnosed in Denmar...

The prognostic value of detailed anatomic site and ultraviolet radiation (UVR) exposure patterns has not been fully determined in cutaneous melanoma. Thus, we reviewed medical records for detailed site in a population-based retrospective Swedish patient cohort diagnosed with primary invasive melanoma 1976 - 2003 (n=5,973). We followed the patients...

Follicular lymphoma (FL) risk is strongly associated with germline genetic variation in human leukocyte antigen (HLA) class II. Cigarette smoking has been suggested to increase FL risk, primarily among women. We hypothesized that amino acids in HLA-antigen D-related ?1 subunit (DRB1) interact with smoking in FL risk, as shown for rheumatoid arthrit...

With today's excellent cure rates for Hodgkin lymphoma (HL), the number of long-term survivors is increasing. This study aims to provide a global assessment of late adverse effects for working-age HL survivors treated with contemporary protocols (combination chemotherapy and limited radiotherapy). From Swedish nationwide registers we identified 101...

The aim was to examine hospitalization due to stroke and acute myocardial infarction, respectively, and to analyze differences between the self-employed and paid employees in the same industries. Data and methods: Data from Statistics Sweden's population register (2003) was linked to National Board of Health and Welfare’s hospital admission registe...

Objectives Analyse mortality differences between self-employed and paid employees with a focus on industrial sector, educational level and gender using Swedish register data. Methods A cohort of the total working population (4 776 135 individuals; 7.2% self-employed; 18–100 years of age at baseline 2003) in Sweden with a 5-year follow-up (2004–200...

In recent decades, the prognosis of Mantle Cell Lymphoma (MCL) has been significantly improved by intensified first-line regimens containing cytarabine, rituximab and consolidation with high-dose-therapy and autologous stem cell transplantation. One such strategy is the Nordic MCL2 regimen, developed by the Nordic Lymphoma Group. We here present th...

Bakgrund: Både bättre och sämre hälsa har tidigare rapporterats hos egenföretagare jämfört med anställda. Egenföretagare rapporterar oftast bättre livs- och arbetstillfredsställelse trots att de arbetar mer, tar kortare semester, är mer sällan sjukskrivna och oftare sjuknärvarande än anställda. Företagsform och bransch påverkar egenföretagares döds...