弥漫性大 B 细胞淋巴瘤患者的结局及影响生存的因素：一项基于人群的分析

Given the rapidly evolving treatment landscape for diffuse large B-cell lymphoma (DLBCL), we performed a contemporary analysis of survival outcomes in patients aged 18 years with DLBCL at the population level using linked administrative data sets in Ontario, Canada (ICES). Among 8675 patients (median age, 67 years; 44% female) treated with frontline rituximab-based therapy, 1675 (19%) were treated with second-line therapy (2L).

The 2-year and 5-year overall survival (OS) from 2L were 33% and 26%, respectively. Univariate analysis demonstrated that curative-intent therapy (autologous stem cell transplantation [ASCT]) (58% of patients) was associated with better OS than palliative radiotherapy (hazard ratio [HR], 0. 56; P < . 0001). Patients aged 60 years showed inferior OS than those aged <60 years (age 60-69 years: HR, 1. 35; P =. 0002; aged 70-79 years: HR, 1. 64; P < . 0001; age 80 years: HR, 2. 08; P < . 0001).

In addition, early relapse was associated with worse outcomes than relapses occurring after 2 years (<3 months: HR, 1. 45; P =. 0002; 3-6 months: HR, 1. 51; P =. 0001; 6-12 months: HR, 1. 88; P < . 0001). Multivariable analysis confirmed these associations while accounting for lactate dehydrogenase, comorbidity burden, frailty, and income.

Exploratory analysis indicated that third-line chimeric antigen receptor T-cell (CAR-T) therapy was associated with improved outcomes compared to a historical cohort of patients treated with palliative therapy before 2020 (2-year OS 56% vs 21%). This population-based analysis suggests that curative-intent therapy (ASCT and CAR-T) is associated with improved OS over conventional treatment approaches. The outcomes presented here provide benchmarks for future analyses aimed at assessing the effects of novel treatments in the 2L on outcomes.