Diffuse large B cell lymphoma in Brazil: Understanding the patient journey to improve healthcare assistance.

Abstract

Abstract Background Diffuse Large B-cell Lymphoma not otherwise specified (DLBCL-NOS) is the most common type of non-Hodgkin lymphoma (NHL). Approximately 60-70% of patients respond to R-CHOP-based first-line regimens. However, around 40-30% of patients will relapse or be refractory (R/R-DLBCL), requiring additional treatments and often facing poor outcomes. CAR-T cell therapy and bispecific antibodies (such as epcoritamab and glofitamab) have represented a paradigm shift for R/R DLBCL with overall response rates 60–80%. Understanding the patient journey and treatment patterns is essential for optimizing care and improving responses and survival. Objective: Describe the epidemiology, treatment approaches, and response patterns of newly diagnosed and relapsed/refractory DLBCL in the Brazilian public healthcare system. Methodology A retrospective analysis was conducted from patients (pts) ≥18 years, newly diagnosed with DLBCL (ICD-10: C83.3) who received R-CHOP-based regimen between January 2015 and December 2023, as reported in the publicly available DATASUS database (http://datasus.saude.gov.br). Clinical information included gender, age, region of residency, date of diagnosis, chemotherapy initiation and completion (by line), number of treatment lines, autologous steam cell transplant (ASCT) and treatment responses to each line. Primary endpoints were overall survival (OS) and progression-free survival (PFS). For descriptive analysis, the IBM-SPSS version 24 was applied. Kaplan-Meier method estimated the OS, whereas Log-Rank tests were used to compare its curves. Results A total of 7730 newly diagnosed DLBCL pts were identified. The median overall age was 56 years/old (range: 18-96), with a slight male predominance (51.5%). 52.1% were white, 39.6% were black, 3.5% were Asian, 4.8% were brown. Most patients lived in Southeast (39.7%) and Northeast (25.1%), followed by South (18.4%), Midwest (9.8%), and North (7%). All patients, as inclusion criteria, received R-CHOP-based first-line therapy. Of those 454 pts (5.8%) received second-line therapy (2L) platinum-based chemotherapy (e.g., ICE/ DHAP/ DHAX/GemOx +/- Rituximab), and only 68 pts (0.87%) were treated in 3L with platinum-based therapy. ASCT was performed in 95 pts (1.2%) as 2L and 32 pts (0.4%) in 3L. Median PFS was 35.3 months (0.1-122.9 mo) after first-line therapy, 7.2 months (0.0-103.1) after 2L, and 6.0 months (0.1-68.9) after 3L. Median OS for the entire cohort was 34 months (0.0-122.9). Conclusions: This study provides valuable insights about patient treatment journey given its large sample size and focus on Brazil's public health system as there is an urgent need to improve the quality of care for patients with relapsed or refractory DLBCL, particularly in 2L and 3L settings. Understanding the real-world treatment journeys and outcomes of DLBCL patients in Brazil is critical to public health planning, reduce regional inequities, and improve care delivery. Nevertheless, limitations of the study include its retrospective design, incomplete follow-up, and limited clinical data granularity. The distribution by sex and age aligns with previously published data, with most patients concentrated in the Southeast and Northeast regions, possibly reflecting disparities in the access to highly specialized treatment (hem-oncology) in other regions. Less than 10% of patients received 2L and 3L treatments with platinum-based regimens, and under 2% undergo ASCT. The main barriers likely include the limited number of centers capable of performing ASCT and restricted availability of newer therapies such as bispecific antibodies and CAR-T cell therapy.