The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment

Abstract

Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma for which a cure is usually the therapeutic goal of optimal treatment. Using a large population-based cohort we sought to examine the factors associated with optimal DLBCL treatment and survival. Methods: DLBCL cases were identified through the population-based Victorian Cancer Registry, capturing new diagnoses for two time periods: 2008–2009 and 2012–2013. Treatment was pre-emptively classified as ‘optimal’ or ‘suboptimal’, according to compliance with current treatment guidelines. Univariable and multivariable logistic regression models were fitted to determine factors associated with treatment and survival. Results: Altogether, 1442 DLBCL cases were included. Based on multivariable analysis, delivery of optimal treatment was less likely for those aged ≥80 years (p < 0.001), women (p = 0.012), those with medical comorbidity (p < 0.001), those treated in a non-metropolitan hospital (p = 0.02) and those who were ex-smokers (p = 0.02). Delivery of optimal treatment increased between 2008–2009 and the 2012–2013 (from 60% to 79%, p < 0.001). Delivery of optimal treatment was independently associated with a lower risk of death (hazard ratio (HR) = 0.60 (95% confidence interval (CI) 0.45–0.81), p = 0.001). Conclusion: Delivery of optimal treatment for DLBCL is associated with hospital location and category, highlighting possible demographic variation in treatment patterns. Together with an increase in the proportion of patients receiving optimal treatment in the more recent time period, this suggests that treatment decisions in DLBCL may be subject to non-clinical influences, which may have implications when evaluating equity of treatment access. The positive association with survival emphasizes the importance of delivering optimal treatment in DLBCL.

RECIL Versus Lugano for Treatment Response Assessment in FDG-Avid Non-Hodgkin Lymphomas: A Head-to-Head Comparison in 54 Patients

“…Patients with histology-proven, treatment-naïve DLBCL or FL, who had undergone [ 18 F]FDG-PET/CT as part of the routine clinical workup between January 2016 and October 2017 for baseline staging, then interim restaging after three immunochemotherapy cycles and at EOT after six cycles of the same treatment were eligible for inclusion in this retrospective study that was conducted at a single tertiary care center. For DLBCL patients, treatment was either R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) or dose-adjusted R-EPOCH (rituximab, etoposide, doxorubicin, vincristine, cyclophosphamide, and prednisone), both of which are considered "optimal" treatments [9]; whereas for FL patients, the treatment was R-BENDA (rituximab and bendamustine) in all cases. The study was approved by the Ethics Committee of the Medical University of Vienna (protocol code: 1701/2018); informed consent was waived due to the retrospective design.…”

Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: A systematic review

“…Patient gender was significantly associated with GRT in five studies. Female cases were significantly more likely to receive GRT in one breast cancer study, 68 and one lung cancer study, 57 whereas male DLBCL cases were more likely to receive GRT, 69 as were male stage C CRC cases, 63 and male high‐risk rectal cancer cases GRT 65 . Ex‐smokers, compared to people who never smoked, were less likely to receive GRT in one DLBCL study 69 and one lung cancer study 57 .…”

“…Suboptimal treatment: R‐CHOP or R‐CHOP variants <6 cycles (other than stages I–II as described before), or any other CTx‐immunotherapy regimen.’ 69 …”

“…This review included various study designs: population‐based cohort studies that typically used registry data ( n = 12 57–59,62–65,67–69,71,118 ), multicenter cohort studies ( n = 4 54,56,61,66 ), and case‐series which followed patients from a single institution ( n = 4 55,60,70,72 ) (Table 1). The studies were conducted in New South Wales (NSW) and the Australian Capital Territory (ACT) ( n = 10 54–56,59,61,65–67,71,118 ), South Australia (SA) ( n = 4 62,63,70,72 ), Victoria (VIC) ( n = 3 57,60,69 ), Australia‐wide ( n = 2 64,68 ), and Queensland (QLD) ( n = 1 58 ). The Australia Cancer Network (ACN) CPGs (which were developed in partnership with the National Health and Medical Research Council (NHMRC)) ( n = 7), National Comprehensive Cancer Network (NCCN) CPGs ( n = 7), and NHMRC CPGs ( n = 5) were the most commonly used CPGs across the 20 included studies (with 7 studies referring to more than 1 CPG) (Table 1).…”

Resolution of Chronic Immune Thrombocytopenia Purpura after Autologous Hematopoietic Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma

“…DLBCL is an aggressive form of NHL in which, complete remission can be attained with optimal therapy. In the present era rituximab and anthracycline-based chemotherapeutic regimens such as RCHOP have remained the standard of care [ 7 ]. RCHOP fails in 30-50% of the cases of DLBCL.…”