Survival trends and disparities in indolent and aggressive non-Hodgkin lymphoma.

Abstract

e23109 Background: Overall survival (OS) in non-Hodgkin lymphoma (NHL) has improved with therapeutic advances. Whether these improvements have occurred uniformly across lymphoma subtypes and sociodemographic groups remains uncertain. We evaluated temporal changes in 5-year OS and examined associations of race/ethnicity and socioeconomic factors with outcomes in indolent and aggressive NHL. Methods: Using Surveillance, Epidemiology and End Results (SEER) 21-registry data, we identified adults diagnosed with NHL from 2000–2017 (N = 108,041) and grouped them into two eras (2000–2010 vs 2011–2017). OS was censored at 60 months. Kaplan–Meier methods estimated 5-year OS by era and subtype, with comparisons by log-rank testing. Multivariable Cox proportional hazards models were fitted separately for indolent and aggressive NHL, adjusting for age, sex, race/ethnicity, era, median household income (per $10,000 increase) and living area (urban/rural). Statistical significance was set at p < 0.05. Results: In Kaplan–Meier analyses of all NHL, 5-year OS was higher for patients diagnosed in 2011–2017 than in 2000–2010 (64.7% vs 56.6%, p < 0.001). Subtype-specific analyses showed similar trends in both indolent (73.8% vs 64.6%, p < 0.001) and aggressive NHL (54.7% vs 47.0%, p < 0.001). Multivariable modeling in indolent NHL indicated that older age was associated with higher mortality (hazard ratio [HR] 1.05 per year; 95% CI, 1.049–1.052; p < 0.001), while female sex was associated with improved survival (HR 0.68; 95% CI, 0.66–0.70; p < 0.001). Compared with White patients, mortality was higher among Black (HR 1.51; 95% CI, 1.43–1.60; p < 0.001), Hispanic (HR 1.21; 95% CI, 1.15–1.27; p < 0.001), and Asian/Pacific Islander (HR 1.11; 95% CI, 1.04–1.19; p = 0.004) patients. Diagnosis in 2011–2017 (HR 0.69; 95% CI, 0.67-0.71; p < 0.001) and higher income (HR 0.95 per $10,000; 95% CI, 0.937-0.953; p < 0.001) were independently associated with lower mortality. In aggressive NHL, increasing age (HR 1.03 per year; 95% CI, 1.032–1.034; p < 0.001) was associated with higher mortality. Compared with White patients, mortality was higher among Black (HR 1.62; 95% CI, 1.56–1.69; p < 0.001), Hispanic (HR 1.18; 95% CI, 1.13–1.22; p < 0.001), and Asian/Pacific Islander patients (HR 1.11; 95% CI, 1.06–1.17; p < 0.001). Female sex (HR 0.79; 95% CI, 0.77–0.81; p < 0.001), diagnosis in 2011–2017 (HR 0.76; 95% CI, 0.74–0.78; p < 0.001) and higher income (HR 0.96 per $10,000 increase; 95% CI, 0.95–0.97; p < 0.001) were associated with improved survival. Living area was not associated with OS in either subtype. Conclusions: Five-year OS for both indolent and aggressive NHL improved in the contemporary era; however, notable racial and socioeconomic disparities persist. Despite overall survival gains, minority racial groups and lower-income communities continue to experience higher mortality, emphasizing the need for strategies to address inequities in lymphoma care.