Clinical Outcomes of Patients With B-Cell Non-Hodgkin Lymphoma in Real-World Settings: Findings From the Hemato-Oncology Latin America Observational Registry Study

Abstract

Purpose: Real-world evidence on non-Hodgkin lymphoma (NHL) management in Latin America is currently lacking. The objective of this study was to describe treatment characteristics and outcomes of NHL in Latin America.

Methods: A total of 2,967 patients with NHL with aggressive and indolent subtypes, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle-cell lymphoma (MCL), and mucosa-associated lymphoid tissue (MALT) lymphoma, with incident or prevalent diagnosis between 2006 and 2015, were retrospectively identified using clinical charts registered in the Hemato-Oncology Latin America Observational Registry. Associations between treatment regimen and age at diagnosis with clinical outcomes within each subtype were estimated using Cox proportional hazard regression.

Results: Most patients with NHL received 1L chemoimmunotherapy, most commonly cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with/without rituximab. Five-year survival rates were higher for MALT lymphoma (90.8%) and FL (87.6%) versus DLBCL (69.0%) and MCL (57.1%), with variations between countries. The median overall survival from first relapse for patients with DLBCL was 6.6 years, with lower risk of death for those diagnosed at age < 65 years (hazard ratio = 0.732; P = .0161). Patients achieved a longer median progression-free survival with 1L rituximab-CHOP (R-CHOP) versus CHOP or rituximab, cyclophosphamide, vincristine, and prednisone (RCVP) (7.7 v 3.0 or 1.8 years, respectively). Use of regimens other than R-CHOP was associated with a higher risk of death/progression for patients with DLBCL (rituximab, ifosfamide, carboplatin, and etoposide/ifosfamide, carboplatin, and etoposide) and FL (CHOP). There was no relationship between treatment prescribed and age at diagnosis with outcomes from first/second relapse in DLBCL and FL.

Conclusion: Differences in treatment outcomes between NHL subtypes were observed, reflecting variations in NHL management and barriers to treatment access in Latin America. These data provide necessary evidence to understand NHL management in this region and highlight the need to improve treatment outcomes for these patients.

FIG 1

Five-year cumulative survival rate of patients by NHL subtypes from diagnosis. The 5-year cumulative survival rates of patients with DLBCL (n = 1,475), FL (n = 578), MCL (n = 183), MALT lymphoma (n = 84), Burkitt lymphoma (n = 60), lymphoplasmacytic lymphoma (n = 35), B-lymphoblastic lymphoma (n = 31), T-cell lymphoma (n = 250), and other types of lymphoma (others, n = 180) from diagnosis are illustrated in the top figure. The survival rate for each NHL subtype further stratified by country, expressed as percentage (%), are detailed in the bottom table. CLL, chronic lymphocytic leukemia; DLBCL, diffuse large B-cell lymphoma; FL, follicular lymphoma; MALT, mucosa-associated lymphoid tissue; MCL, mantle-cell lymphoma; NA, not available; NHL, non-Hodgkin lymphoma; SLL, small lymphocytic lymphoma.

FIG 2

OS of patients by NHL subtypes from start of frontline treatment. Kaplan-Meier survival curves depicting the OS of patients with DLBCL (n = 1,387), FL (n = 544), MCL (n = 172), and MALT lymphoma (n = 77) from the start of first-line therapy; the results are described when the number of patients at risk at the beginning of the observation period was ≥ 10. DLBCL, diffuse large B-cell lymphoma; FL, follicular lymphoma; MALT, mucosa-associated lymphoid tissue; MCL, mantle-cell lymphoma; NHL, non-Hodgkin lymphoma; OS, overall survival.

FIG 3

OS of patients by NHL subtypes from first relapse. Kaplan-Meier survival curves depicting the OS of patients with DLBCL (n = 393), FL (n = 204), MCL (n = 94), and MALT lymphoma (n = 17) from first relapse; the results are described when the number of patients at risk at the beginning of the observation period was ≥ 10. DLBCL, diffuse large B-cell lymphoma; FL, follicular lymphoma; MALT, mucosa-associated lymphoid tissue; MCL, mantle-cell lymphoma; NHL, non-Hodgkin lymphoma; OS, overall survival.

FIG A1

OS of patients by NHL subtypes from second relapse. Kaplan-Meier survival curves depicting the OS of patients with DLBCL (n = 147), FL (n = 66), and MCL (n = 36) from second relapse; the results are described when the number of patients at risk at the beginning of the observation period was ≥ 10. In total, 152 patients with DLBCL, 70 patients with FL, 38 patients with MCL, and 3 patients with MALT lymphoma received treatment for second relapse. For DLBCL, the median OS from second relapse was 1.9 years (95% CI, 0.43 to n.e.), whereas the median OS from second relapse for FL or MCL was 5.0 years (95% CI, 1.9 to n.e.) or 4.4 years (95% CI, 0.8 to n.e.), respectively. Outcome analysis was not conducted for MALT lymphoma because of small patient sample size. DLBCL, diffuse large B-cell lymphoma; FL, follicular lymphoma; MALT, mucosa-associated lymphoid tissue; MCL, mantle-cell lymphoma; n.e., not estimable; NHL, non-Hodgkin lymphoma; OS, overall survival.

FIG A2

PFS of patients by NHL subtypes from second relapse. Kaplan-Meier survival curves depicting the PFS of patients with DLBCL (n = 145), FL (n = 64), and MCL (n = 35) from second relapse; the results are described when the number of patients at risk at the beginning of the observation period was ≥ 10. The median PFS from second relapse was 1.3 years (95% CI, 0.4 to 6.2) in DLBCL, 4.3 years (95% CI, 1.8 to n.e.) in FL, and 1.5 years (95% CI, 0.8 to 4.4) in MCL. DLBCL, diffuse large B-cell lymphoma; FL, follicular lymphoma; MCL, mantle-cell lymphoma; n.e., not estimable; NHL, non-Hodgkin lymphoma; PFS, progression-free survival.