Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Jul;149(7):3691-3700.
doi: 10.1007/s00432-022-04179-8. Epub 2022 Aug 17.

Adherence to guidelines-recommended diagnostic testing was associated with overall survival in patients with diffuse large B-cell lymphoma after rituximab-based treatment: an observational cohort study

Fei Yang  1 , Ju Zhang  2 , Anup Abraham  3 , Jessie T Yan  2 , Richard D Hammer  4 , Matthew S Prime  5
Affiliations
Observational Study

Adherence to guidelines-recommended diagnostic testing was associated with overall survival in patients with diffuse large B-cell lymphoma after rituximab-based treatment: an observational cohort study

Fei Yang et al. J Cancer Res Clin Oncol. 2023 Jul.

Abstract

Purpose: This study assessed the impact of adherence to guidelines-recommended diagnostic testing on treatment selection and overall survival (OS) in patients with diffuse large B-cell lymphoma (DLBCL) initiated on rituximab-based first line of treatment (1-LOT).

Methods: This retrospective cohort study used a nationwide electronic health record-derived de-identified database, including diagnostic testing information on immunohistochemistry (IHC), fluorescence in situ hybridization (FISH) and karyotype analysis that were abstracted from pathology reports or clinical visit notes, where available. The study included patients above 18 years old who were diagnosed with DLBCL between January 2011 and December 2019 and initiated on rituximab-based 1-LOT. Patients were classified into 'non-adherence,' 'partial-adherence' and 'complete-adherence' groups according to the evidence/documentation of a confirmed known result for IHC and molecular profiling tests (FISH and karyotyping) on a selection of the markers prior to the initiation of 1-LOT. Logistic regression was used to evaluate associations of adherence to diagnostic testing with 1-LOT between R-CHOP and other rituximab-based regimens. Median OS after the start of rituximab-based 1-LOT was calculated using the Kaplan-Meier method. Multivariable-adjusted Cox proportional hazards regression was used to assess the risk of all-cause death after initiation of 1-LOT by the degrees of adherence to guidelines-recommended diagnostic testing.

Results: In total, 3730 patients with DLBCL who initiated on rituximab-based 1-LOT were included. No association was found between adherence to guidelines-recommended diagnostic testing and treatment selection of 1-LOT for R-CHOP versus other rituximab-based regimens. Patients with a higher degree of adherence to guidelines-recommended diagnostic testing survived longer (median OS at 5.1, 6.9 and 7.1 years for 'non-adherence,' 'partial-adherence' and 'complete-adherence' groups, respectively [log-rank p < 0.001]) and had a decreased mortality risk (multivariable-adjusted hazard ratio with 95% confidence intervals at 0.83 [0.70-0.99] for 'partial-adherence' and 0.77 [0.64-0.91] for 'complete-adherence' groups, respectively).

Conclusion: Patients' adherence to guidelines-recommended diagnostic testing were associated with better survival benefit, reinforcing the need for adoption of diagnostic testing guidelines in routine clinical care.

Keywords: DLBCL; Diagnostic testing; Guideline adherence; Overall survival.

PubMed Disclaimer

Conflict of interest statement

FY, JZ, JTY, and MSP are employed by and hold shares in Roche; RDH provides consultancy and receives honoraria and research funding from Roche; AA has nothing to disclose.

Figures

Fig. 1
Fig. 1
Flow Diagram of Study Population
Fig. 2
Fig. 2
Trends of guidelines-recommended diagnostic testing prior to initiation of 1-LOT with rituximab-based treatment between 2011 and 2019. Abbreviations: DLBCL diffuse large B-cell lymphoma, FISH  fluorescence in situ hybridization, IHC  immunohistochemistry
Fig. 3
Fig. 3
Unadjusted Kaplan–Meier curves of overall survival since initiation of rituximab-based first-line therapy by the degrees of adherence to guidelines-recommended diagnostic testing
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Alizadeh AA, Eisen MB, Davis RE et al (2000) Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature 403:503–511 - PubMed
    1. Barrans S, Crouch S, Smith A et al (2010) Rearrangement of MYC Is associated with poor prognosis in patients with diffuse large B-cell lymphoma treated in the era of rituximab. J Clin Oncol 28:3360–3365 - PubMed
    1. Birnbaum B, Nussbaum N, Seidl-Rathkopf K, et al (2020) Model-assisted cohort selection with bias analysis for generating large-scale cohorts from the EHR for oncology research. 10.48550/arXiv.2001.09765
    1. Chapuy B, Stewart C, Dunford AJ et al (2018) Molecular subtypes of diffuse large B cell lymphoma are associated with distinct pathogenic mechanisms and outcomes. Nat Med 24:679–690 - PMC - PubMed
    1. Coiffier B, Lepage E, Brière J et al (2002) CHOP Chemotherapy plus Rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. New Engl J Medicine 346:235–242 - PubMed

Publication types

MeSH terms