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. 2022 Jan;126(1):134-143.
doi: 10.1038/s41416-021-01525-4. Epub 2021 Oct 5.

Diffuse large B cell lymphoma (DLBCL) in patients older than 65 years: analysis of 3 year Real World data of practice patterns and outcomes in England

L Hounsome #  1 , T A Eyre #  2 , R Ireland  3 , A Hodson  4 , R Walewska  5 , K Ardeshna  6 , S Chaganti  7 , P McKay  8 , A Davies  9 , C P Fox  10 , N Kalakonda  11 , P A Fields  12
Affiliations

Diffuse large B cell lymphoma (DLBCL) in patients older than 65 years: analysis of 3 year Real World data of practice patterns and outcomes in England

L Hounsome et al. Br J Cancer. 2022 Jan.

Abstract

Background: We wished to examine treatment and outcome patterns in older diffuse large B-cell lymphoma (DLBCL) patients, with a focus on the effect of route-to-diagnosis to outcome.

Methods: Data were extracted from Public Health England's National Cancer Registration and Analysis Service between 2013 and 2015 included route-to-diagnosis, disease characteristics and survival for 9186 patients ≥65 years. Systemic Anti-Cancer Therapy data identified front-line regimens, cycles and doses.

Results: Route-to-diagnosis were emergency (34%), NHS urgent cancer pathway (rapid haemato-oncologist review <2 weeks), (29%) and standard GP referral (25%). The most common regimen was R-CHOP (n = 4392). 313 patients received R-miniCHOP (7% of R-CHOP). For all patients, 3-year overall survival (OS) for 65-79 years was 57% and for ≥80 years was 32%. Three-year OS for R-CHOP-treated patients diagnosed via emergency presentation was 54% (adjusted hazard ratio (HR) 1.63, p < 0.01) and 75% (adjusted HR 0.81, p < 0.01) on the NHS urgent cancer pathway (reference HR:1.00: GP referrals). 3-year OS was 54% for both R-miniCHOP and R-CHOP in ≥80 years.

Conclusions: Our comprehensive population analysis is the first to show that the NHS urgent cancer pathway is associated with a superior survival after adjusting for multiple confounders. Equivalent survival for R-CHOP and R-mini-CHOP was demonstrated in those ≥80 years.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Overall survival all DLBCL patients by age.
a age 65–79 vs ≥80 years, b ages in 5-year subgroups.
Fig. 2
Fig. 2. Overall survival all patients DLBCL by route to diagnosis by age.
a age 65–79 years (b) age ≥80 years.
Fig. 3
Fig. 3. Overall survival of all R-CHOP treated patients by.
a year of diagnosis (b) by age 65–79, ≥80 years (c) age and sex (d) stage at diagnosis (e) route to diagnosis (f) deprivation.
Fig. 4
Fig. 4. Overall survival R-miniCHOP treated patients by.
a all patients (b) by age 65–79, ≥80 years (c) route to diagnosis (d) age and sex.
Fig. 5
Fig. 5
OS for patients aged ≥80 years, treated with either R-CHOP or R-mini-CHOP.
See this image and copyright information in PMC

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