Shifting patterns in PMBCL and DLBCL care: The role of community oncology centers in the U.S.

Abstract

e19071 Background: Historically, clinical trials and adoption of novel therapies for oncology have been concentrated within academic centers, which are associated with better research infrastructure and specialized expertise. However, this juxtaposes current care patterns, as many patients receive treatment in community centers. This analysis aimed to determine where patients are treated, prescribed CAR-T and bispecific therapies today and to characterize referral pathways between community and academic centers. Methods: 23,143 incident-treated patients with diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma (PMBCL) were identified in a U.S. Komodo open and closed claims database between July 2023 and June 2025. Patients were mapped to 18,666 hematologist and/or oncologist treaters, who in turn were mapped to their primary affiliation using Definitive Healthcare affiliations. Treaters were mapped to 191 out of 217 academic medical centers in the US and 2,297 community centers. Results: A total of 70% of patients were treated exclusively in community centers, 23% exclusively in academic centers, and 7% received care in both settings over the study period. On average, community centers treated 10 patients, and academic centers treated 38 patients. Among centers with evidence of CAR-T and bispecific treatment capabilities, averages increased to 33 patients at community centers and 62 patients at academic centers. Within two years of diagnosis, 3% of patients received CAR-T therapy, 43% of whom received it in a community center. Bispecific antibody therapies were received by 2% of patients, of whom 50% received it in a community center. Overall, only 16% of patients had a referral to another center, of which a minority of referrals were to academic centers. Among patients who were treated with CAR-T or bispecific therapies, referral patterns shifted even further toward community centers: only 11% of patients treated with CAR-T and 13% of patients treated with bispecific therapy were referred to an academic center for treatment. Conclusions: In this national cohort, most patients with DLBCL/PMBCL received care exclusively in community centers, with advanced therapies such as CAR-T and bispecific antibodies delivered across both community and academic settings. Inter-center referrals were uncommon, and referrals to academic centers were particularly limited among patients receiving advanced therapies. These findings highlight the importance of including community centers with demonstrated treatment capabilities when evaluating potential sites for clinical trial recruitment.