Real-world treatment patterns and clinical outcomes among patients with diffuse large B-cell lymphoma in a US healthcare claims database

Abstract

Treatment options for diffuse large B-cell lymphoma (DLBCL) have expanded, but real-world data on treatment patterns and outcomes remain limited. This study examined real-world outcomes in DLBCL patients treated between 10/1/2015 and 6/30/2024. Patients were stratified by lines of therapy (LOT) and treatments (1L rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone [R-CHOP]; 2L stem cell transplant [SCT]; and chimeric antigen receptor T-cell [CAR T] therapy (any LOT). Variables were reported descriptively. Time-to-event outcomes were assessed using the Kaplan-Meier method. LOT data from 9875 patients were included. R-CHOP-based regimens were the most common 1L treatment (61.7%-67.3% in 2016-2023; 49.4% in 2024). Conventional chemoimmunotherapy use decreased in 2L (81.6% in 2016 to 41.9% in 2024) and 3L (47.6% in 2016 to 22.1% in 2024), while novel therapies increased (43.0% in 2L and 55.9% in 3L in 2024). Median overall survival declined across LOT (1L: 58.1 months; 2L: 30.0 months), as did median time to next treatment (1L: 36.1 months; 2L: 10.6 months). Twelve-month treatment failure rates were 36.0% after 1L, 51.8% after 2L, and 42.2% after CAR T. Among CAR T recipients, 93 received one of 36 distinct subsequent regimens, indicating no standard of care. These findings highlight the unmet needs in DLBCL.

Fig. 1. Study design.

CAR T chimeric antigen receptor T-cell, DLBCL diffuse large B-cell lymphoma, LOT line of therapy, SCT stem cell transplant, TTNT time to next treatment or death, OS overall survival. ^aFollow-up period was defined as the time from the index date to death, end of continuous enrollment, or end of study period,whichever occurred the earliest.

Fig. 2. LOT identification.

DLBCL diffuse large B-cell lymphoma, ICD International Classification of Diseases, LOT line of therapy, NHL non-Hodgkin lymphoma. ^aCorresponding number of patients: 9875.

Fig. 3. Distribution of therapies among patients with DLBCL by year.

Time period: January 1, 2016 to June 30, 2024. A single patient may contribute to multiple lines of therapy. 1L first line, 2L second line, 3L third line, CAR T chimeric antigen receptor T-cell, CIT chemoimmunotherapy, DLBCL diffuse large B-cell lymphoma, IT immunotherapy, mono, monotherapy, Pola polatuzumab vedotin, R-CHOP rituximab cyclophosphamide doxorubicin and vincristine (with or without corticosteroids), R-CHP rituximab cyclophosphamide and doxorubicin (with or without corticosteroids), R-squared rituximab and lenalidomide, SCT stem cell transplant, Tafa tafasitamab.

Fig. 4. OS and TTNT by LOT.

Per Optum’s deidentification policies, patient counts <5 were masked. 1L first line, 2L second line, 3L third line, LOT line of therapy, OS overall survival, TTNT time to next treatment or death.

Fig. 5. OS and TTNT by treatment.

Per Optum’s deidentification policies, patient counts <5 were masked. 1L first line, 2L second line, CAR T chimeric antigen receptor T-cell, OS overall survival, R-CHOP rituximab cyclophosphamide doxorubicin and vincristine (with or without corticosteroids), SCT stem cell transplant, TTNT time to next treatment or death.