Outcomes of diffuse large B-cell lymphoma and high-grade B-cell lymphoma in elderly patients aged ≥ 80 years-old treated in first line therapy: An analysis of the bra-DLBCL multicenter, real-world registry, retrospective study

Abstract

Abstract Introduction Only a few studies have been conducted in elderly patients with diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma (HGBL), especially in patients aged 80 years or older. Moreover, while patients in developed countries may have access to novel therapies, elderly patients in Low and Low-middle income countries have access mainly to immunochemotherapy or paliative care. The current study aimed to describe the outcomes of newly diagnosed DLBCL or HGBL diagnosed in individuals aged 80 years or older and treated in first-line therapy in a cohort of patients from a retrospective Study in Brazil. Methods BRA-DLBCL is a Brazilian multicenter retrospective observational study aimed at generating real-world data (RWD) in patients with newly diagnosed DLBCL and high-grade B-cell lymphoma. Patients registered from 2017 to 2023 at centers located in the southeast and northeast regions of Brazil, which account for more than two-thirds of the Brazilian population, were included. The primary outcome was progression-free survival, and secondary outcomes included overall survival, relapse, and non-relapse mortality. Univariable analyses were conducted using Kaplan-Meier and cumulative incidence curves and compared with the log-rank and Gray tests, respectively. BRA-DLBCL is funded by AstraZeneca. Results A total of 76 patients were included. The median follow-up was 38 months. The median age was 87 years (SD: 5), and 45% were female. ECOG performance status 0-1 was present in 57% of patients, and most patients had stage III-IV disease (73%). The preferred regimen in these treatment naïve patients was R-mini-CHOP (63%), followed by R-CHOP (15%). The intervals between symptoms and diagnosis, and between diagnosis and treatment, were 40 and 29 days, respectively. Cell of origin was non-germinal center B-cell (53%), germinal center B-cell (42%), or high-grade B-cell lymphoma (5%). Notably, only 28% did not have any extra-nodal involvement. The three-year progression-free survival rate was 39% (95%CI, 29-52%). Three-year overall survival was 45% (95%CI 35-59%). Three-year relapse rate was 35% (95%CI, 26-48%), and 3-y non-relapse mortality was 26% (95%CI, 18-38%). Discussion In this multicenter study of elderly, ≥ 80 years-old Brazilian patients, we found surprisingly good outcomes, considering the poor ECOG performance status profile and the pattern of advanced disease in this population. We noticed that both time from symptoms to diagnosis and time from diagnosis to treatment were long, which might have impacted the ECOG performance status and the frequency of stages III-IV disease, as well as some survival bias. Although the primary cause of failure was disease relapse/progression, the non-relapse mortality rate was high (26%), even though R-mini-CHOP was the preferred treatment. In this population, some of these non-relapse-related deaths can be non-treatment related, but future studies should test less toxic, more targeted therapies in patients ≥ 80 years.