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

Hounsome, L.; Eyre, T. A.; Ireland, R.; Hodson, A.; Walewska, R.; Ardeshna, K.; Chaganti, S.; McKay, P.; Davies, A.; Fox, C. P.; Kalakonda, N.; Fields, P. A.

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.

Citation

Hounsome, L., Eyre, T. A., Ireland, R., Hodson, A., Walewska, R., Ardeshna, K., …Fields, P. A. (2022). 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. British Journal of Cancer, 126(1), 134-143. https://doi.org/10.1038/s41416-021-01525-4

• Journal Article Type: Article
• Acceptance Date: Aug 11, 2021
• Online Publication Date: Oct 5, 2021
• Publication Date: Jan 1, 2022
• Deposit Date: Feb 8, 2023
• Publicly Available Date: Feb 8, 2023
• Journal: British Journal of Cancer
• Print ISSN: 0007-0920
• Electronic ISSN: 1532-1827
• Publisher: Cancer Research UK
• Peer Reviewed: Peer Reviewed
• Volume: 126
• Issue: 1
• Pages: 134-143
• DOI: https://doi.org/10.1038/s41416-021-01525-4
• Keywords: Cancer Research; Oncology
• Public URL: https://nottingham-repository.worktribe.com/output/17078621
• Publisher URL: https://www.nature.com/articles/s41416-021-01525-4