弥漫大 B 细胞淋巴瘤各治疗线的患者特征、医疗资源利用与费用——德国理赔数据研究

Aim: Given the limited availability of real world diffuse large B-cell lymphoma (DLBCL) data in Germany, we assessed the baseline characteristics, treatments, clinical complications, healthcare resource utilization and costs of DLBCL across treatment lines using German claims data.

Materials & methods: In a retrospective cohort study using claims data from a German sickness fund (AOK PLUS), we identified patients with an incident DLBCL diagnosis between 2012 and 2022. Using an algorithm based on German treatment guidelines, patients were stratified into first (1L), second (2L) and third line (3L) treatment.

We then descriptively analyzed baseline characteristics, treatments, clinical complications, healthcare resource utilization and costs. Results: A total of 2423 patients with DLBCL and 1L treatment were included in the study (49. 1% female; mean age: 69. 7 years; mean CCI: 7. 0; median follow-up: 29. 3 months). A total of 1209 (49. 7%) and 505 (20. 8%) patients progressed to 2L and 3L, respectively. A total of 209 patients received a stem cell transplant (SCT; mean age: 56. 1 years); 37 received a chimeric antigen receptor T-cell therapy (CAR-T; mean age: 60. 8 years). Most patients had at least one DLBCL related hospitalization during follow-up (1L: 79. 2%; 2L: 60. 0%; 3L: 71. 9%; mean length of stay [days/patient year]: 1L: 15. 2; 2L: 6. 4; 3L: 14. 2), with corresponding hospitalization costs of 12,777 (1L), 5993 (2L) and 17,408 (3L) per patient year.

Clinical complications were common, particularly in 3L, including neutropenia (1L: 31. 9%; 2L: 27. 0%; 3L: 46. 9%), pneumonia (1L: 19. 6%; 2L: 16. 8%; 3L: 30. 3%), anemia (1L: 17. 8%; 2L: 18. 7%; 3L: 35. 2%), thrombocytopenia (1L: 17. 3%; 2L: 21. 8%; 3L: 45. 1%) and sepsis (1L: 14. 6%; 2L: 13. 0%; 3L: 23. 2%).

Conclusion: The high proportion of patients with second or later-line treatment (indicating a relapse or refractory disease), the low number of SCTs together with many clinical complications and healthcare resource use underscore the need for novel effective and well-tolerated DLBCL treatment options.

What is this article about? Diffuse large B-cell lymphoma (DLBCL) is a fast-growing cancer that is usually first treated with a combination of chemotherapy and immunotherapy called R-CHOP. While R-CHOP helps most patients, for some patients the cancer returns or they do not respond to the treatment.

This study tries to better understand how DLBCL is treated in the real world, looking at treatments, complications, and the use of healthcare services among DLBCL patients.

We used data from a large German health insurance fund, covering 3. 5 million people from 2010 to 2022. For the study, we included patients diagnosed with DLBCL for the first time between 2012 and 2022 and followed them until 2022 or until they died. Patients were tracked through different lines of therapy. What were the results?

We identified 2432 patients with first-line treatment, with an average age of 69. 7 years. Nearly half of these patients needed further treatment lines. Most patients (about 85% in first-line treatment) received chemotherapy combined with rituximab. A small number of typically younger patients received advanced therapies like stem cell transplants or so-called chimeric antigen receptor T-cell therapy.

Hospitalizations among patients were common, with around 6 to 15 hospital days per year and costs ranging from around 6000 to 17,000 per year, depending on the treatment line. Common complications included neutropenia, pneumonia, anemia, thrombocytopenia and sepsis. Blood and platelet transfusions were also common, especially in later treatment lines. What do the results mean? With nearly half of the patients having more than one line of treatment, our study indicates that many patients experience relapses or do not respond well to treatment initially.

We also observed a high number of hospitalizations and complications, showing the negative impact of DLBCL despite current treatments. This highlights the need for n