Differences in outcomes for elderly patients with DLBCL treated at academic vs community programs: A 10-year survival analysis.

Abstract

7066 Background: Diffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell malignancy that primarily affects older adults. Optimal treatment management in the geriatric population is challenging due to the high-risk disease biology and their age-specific vulnerabilities. Combination chemotherapy is effective, however, due to frailty often a dose-reduced regimen is administered. This large population real-world study compares demographic, clinical and survival characteristics of patients older than 75 years and compares Academic Cancer Programs (ACP) vs Community Cancer Programs (CCP). Methods: A retrospective analysis using the National Cancer Database was conducted on 103,671 patients (ACP: 51,848; CCP: 51,823) diagnosed with DLBCL between 2004 and 2022 was carried out. ACP included academic and National Cancer Institute-designated research centers; CCP included community, comprehensive community, and integrated network cancer programs. Kaplan-Meier and Cox regression models were used to compare overall survival (OS), adjusting for: age, race/ethnicity, insurance status, Charlson-Deyo comorbidity score, and distance from treating facility. Results: Patients in ACP and CCP were mostly females with a median age of 81 years. For both cohorts the majority were non-Hispanics and Whites; however, for ACP it was noted a higher rate of Hispanics (6% vs 5%) and Blacks (5% vs 3%) compared to CCP. Most of the patients in both groups were from the Metropolitan area, but the median distance in miles for ACP was 9.0 vs 7.4 in CCP. Treatment rates were higher for ACP vs community settings (63% vs 59%, p<0.001), with more patients presenting at Stage IV (36% vs 33%, p<0.001). Better OS was noted in elderly patients treated at ACP, p<0.001. The median OS for ACP was of 1.79 years vs 1.50 years at CCP, which was consistent with a longer median follow up time of 17.7 months vs 14.1, p<0.001. This survival advantage remained consistent throughout long-term observation, with 2-year OS rates of 49% at ACP [CI: 0.48,0.49] vs 46% at CCP [CI: 0.459,0.468], 5-year OS of 34% [CI: 0.336,0.346] vs 32% [CI: 0.317,0.327], and 10-year OS of 16% [CI: 0.154,0.164] vs 15% [CI: 0.142,0.151], respectively. Conclusions: Among patients aged ≥75 years with DLBCL, OS differed by treatment facility type, with a statistically significant but modest survival advantage observed among patients treated at ACP compared with CCP (log-rank p<0.001). This difference occurred in the context of higher treatment rates and greater disease severity at presentation. Given the relatively small absolute survival differences, these findings suggest that care for older adults with DLBCL is largely standardized across practice settings; however, this highlights an opportunity to optimize treatment delivery and intensity, supportive care, and geriatric-focused management in both academic and community programs.