Palliative care and hospice utilization in patients with refractory or relapsed diffuse large B-cell lymphoma in the era of novel therapies.

Abstract

e24051 Background: Around 40% of patients with diffuse large-B cell lymphoma (DLBCL) experience relapsed/refractory (r/r) disease and have very poor prognosis. Since 2018, the availability of chimeric antigen receptor T-cells (CART) and other therapies targeting CD19, CD20, and CD79b have expanded treatment options for patients with r/r DLBCL. Despite this, most patients with r/r DLBCL die from their disease and palliative care (PC)/hospice remain integral to their care. This study aimed to assess the changes in PC/hospice utilization before and after the introduction of CART at our institution (1/1/2018). Methods: Electronic medical records at a single center were retrospectively reviewed for deceased patients with r/r DLBCL. Patients were excluded if they died without active lymphoma or if they were referred to PC/hospice for a reason unrelated to lymphoma diagnosis. Demographic, clinical, and PC and hospice utilization characteristics were extracted and compared using descriptive statistics. Results: We identified 87 patients who had first r/r DLBCL between 1/1/2010 – 12/31/2017 (pre-CART era) and 95 patients between 1/1/2018 – 9/10/2024 (post-CART era). There were no differences in age, gender, stage, LDH, CNS involvement, IPI score at diagnosis or lines of therapy received in the pre- and post-CART era (p > 0.05). PC referral/consult rates were 57.5% in the pre-CART era and 68.4% in the post-CART era (p-value = 0.715). In the pre-CART era, 78.2% had hospice referral/consult compared with 80% in the post-CART era (p-value = 0.433). Median time from last treatment to death was 95 (IQR 44-278) days in the pre-CART era and 51 (IQR 18-132) days in the post-CART era (p = 0.001). Conclusions: Overall rates of PC and hospice utilization at our institution have remained similar for patients with r/r DLBCL before and after the availability of CART and novel therapies. The time from last treatment to death is shorter in the post-CART era, reflecting the increase in treatment options for r/r DLBCL. While most patients received PC and hospice referrals, 20-30% of patients were not referred to these services, demonstrating a continued need to optimize end of life services to improve quality of life in patients with r/r DLBCL. Characteristics Pre-CART era (n=87) Post-CART era (n=95) p value Autologous stem cell transplant 23 (26.4%) 10 (10.5%) 0.005 CART 4 (4.6%)* 24 (25.3%) <0.001 Novel therapies 11 (12.6%) 30 (31.6%) 0.002 % PC consult 50 (57.5%) 65 (68.4%) 0.715 % Hospice consult 68 (78.2%) 76 (80%) 0.433 Days from last treatment to death (median, IQR) 95 (44-278) 51 (18-132) 0.001 Days from PC to death (median, IQR) 33 (9-241.3) 32 (13-191) 0.963 Days from hospice to death (median, IQR) 16.5 (4-40) 14 (4-33.25) 0.536 In hospital location of death 32 (33.7%) 16 (18.4%) 0.081 *Patients received CART on clinical trials or for subsequent relapses after 2018.