National trends in non-Hodgkin lymphoma incidence in the CAR-T era: A population-based analysis using SEER Explorer data.

Abstract

e19062 Background: Non-Hodgkin lymphoma (NHL) is a common hematologic malignancy in the United States. Chimeric antigen receptor T-cell (CAR-T) therapies were first approved in 2017, representing a major therapeutic milestone. However, population-level incidence trends of NHL in the CAR-T era remain incompletely characterized. We evaluated national NHL incidence trends before and after the introduction of CAR-T therapies using SEER Explorer data. Methods: Using SEER Explorer, we analyzed age-adjusted NHL incidence rates (per 100,000 population) from 2010 to 2021. Era-based comparisons were pre-specified based on FDA approval timelines: pre–CAR-T era (2010–2016) and post–CAR-T era (2018–2021), with 2017 excluded as a transition year. Mean annual incidence rates were calculated for each era. Secondary analyses examined incidence patterns stratified by age group and sex. Results: The mean age-adjusted incidence rate of NHL declined from 19.71 per 100,000 in the pre–CAR-T era to 18.95 per 100,000 in the post–CAR-T era, representing a 3.9% reduction. Across both eras, incidence remained highest among adults aged ≥65 years, who accounted for the majority of NHL cases nationally. Although modest declines were observed in the post–CAR-T era among age groups <65 years, age-related disparities persisted. Males consistently demonstrated higher NHL incidence than females throughout the study period, with parallel temporal trends and modest post–CAR-T declines by sex. Conclusions: In this population-based analysis using age-adjusted SEER data, NHL incidence demonstrated a modest decline in the post–CAR-T era compared with the pre–CAR-T period. After accounting for COVID-19–related reporting disruptions, long-term incidence trends remained stable. Persistently higher incidence among older adults and males highlights ongoing demographic disparities and underscores the need for continued epidemiologic surveillance in the CAR-T era. Population-level incidence patterns of NHL in the pre- and post–CAR-T eras. Outcome Pre–CAR-T (2010–2016) Post–CAR-T (2018–2021) Key Finding Mean age-adjusted incidence (per 100,000) 19.71 18.95 3.9% overall decline Incidence trend (APC/AAPC) — — Modest negative trend Age ≥65 years Highest incidence Highest incidence Majority of cases Age <65 years Lower incidence Modest Declined Consistent pattern Age pattern ↑ with age ↑ with age Persistent disparity Sex pattern Male > female Male > female Stable male predominance Abbreviations: NHL, non-Hodgkin lymphoma; CAR-T, chimeric antigen receptor T-cell; APC, annual Percent Change; AAPC, average Annual Percent Change. Incidence rates are per 100,000 population and age-adjusted to the 2000 US standard population. 2017 was excluded as a transition year.