The Impact of Race and Ethnicity on Diffuse Large B-Cell Lymphoma (DLBCL) Outcomes within the Veterans Health Administration (VHA)

• Published in: Blood 2020-11, Vol.136 (Supplement 1), p.3-4
• Main Authors: Williams, Madison H., Williams, Ryan A., Blaize, Jean Pierre, Ananth, Snegha, Gregorio, David, Rosas, Gerardo Manuel, Song, Michael M., Warnecke, Brian, Pandya, Abhishek, Djoufack Djoumessi, Lakene Raissa, Dee, Vivian, Nazarewicz, Phillip, Franklin, Kathleen, Toro, Juan J., Mader, Michael, Nooruddin, Zohra
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2020-142118

Introduction Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), constituting 25% of NHL cases (Teras, 2016). Although survival rates have improved, with a 5-year relative survival of 63.8% in the United States (SEER Cancer Statistics, 2018), outcomes in DLBCL remain heterogeneous with inferior survival amongst some patient subgroups. Racial and ethnic disparities in access to care and outcomes are well-established and are critical issues across a number of malignancies, including NHL (Shenoy, 2011; Griffiths, 2010). The purpose of this study was to assess for racial and ethnic differences in patient and disease characteristics at diagnosis, and in outcomes for patients diagnosed with DLBCL within the Veterans Health Administration (VHA), where access to care may be less susceptible to other socioeconomic factors. Methods Trained abstractors performed a retrospective chart review of 2036 randomly selected patients seen in the VHA nationwide who were diagnosed with lymphoma between 01/01/2011 and 12/31/2017. We included patients diagnosed with DLBCL and excluded patients based on the criteria in Figure 1. We evaluated baseline patient and disease characteristics, including Eastern Cooperative Oncology Group (ECOG) performance status, stage at diagnosis, International Prognostic Index (IPI) score, pathology reports to identify high-grade lymphomas, and response to first-line treatment. Results A total of 971 patients met inclusion criteria for analysis. Patients were predominantly male, white, had a median age of 67, and presented primarily with advanced disease (Table 1). Patients in each subgroup presented with similar rates of stage III and IV disease, with no statistically significant difference in stage at presentation amongst each racial subgroup (white vs black, P=0.85; white vs Hispanic, P=0.30; white vs other, P=0.11). Most patients in each racial/ethnic group had a good performance status at diagnosis, with ECOG 0-2 in 75.4 - 82.5% of patients in each subgroup. The entire study population had an objective response rate (ORR) of 87.4% (complete response (CR) rate 66%) (Table 2). Response rates were similar across the 4 subgroups, with the majority of patients achieving a complete response (CR) after first-line therapy (66.7%, 68.9%, 65.3%, and 70% for black, Hispanic, white, and other/unknown patients, respectively). There were no statistically significant differences in ORR amongst subgroups (white vs black,