DIFFUSE LARGE B-CELL LYMPHOMA IN BRAZIL: A COMPREHENSIVE ANALYSIS OF SOCIODEMOGRAPHIC PATTERNS

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma, with around 60% of patients being progression-free in the long-term with standard treatment. Brazil is one of the largest countries in the world where 70% of the population is treated by the public health system (Sistema Único de Saúde—SUS). Considering the country disparities across different regions, there is a lack of studies focusing on sociodemographic aspects of patients with DLBCL.

Methods: This is an observational, retrospective, descriptive study, based on real-world data extracted from the SUS service records (claim data), provided by the Information Department of Informatics of SUS (DATASUS). Patients 18 years old or more with a diagnosis of DLBCL, between 2015 and 2023 and treated with immunochemotherapy (rituximab-based) were included.

Results: We analyzed 21876 patients. Median age at diagnosis was 59y (interquartile range = 23y) and most patients were between 60 and 69y (24.7%). There were 52.5% males and 52.1% whites. 61% of patients presented with advanced stage disease. During the study period, there was a steady increase of 0.6% in diagnosis per year. Most patients came from the southeast region of Brazil (42.7%), with the fewest proportion of localized disease (35.3%). Most cases had received treatment outside the city of residence (58.2%), especially in the country's northeast (62.4%). Ninety percent of patients received only immunochemotherapy and 8% combined treatment (with radiotherapy). Most patients received only first-line treatment (93.9%), while 12.5% and 3.9% received second and third lines of therapy. The mean number of cycles in the first, second, and third lines were 5.9, 4.7, and 5.0, respectively. Figure 1 illustrates a map of Brazil highlighting the regional differences across the country.

Conclusions: This is the largest real-world study of DLBCL patients in Brazil. The southeast country's region has the majority of treating centers and hence most cases. It is common for patients to leave their homes to receive treatment, especially in poorer regions such as the northeast. Radiotherapy was rarely given as a treatment option. Most cases were treated in the first line, while the proportion in latter lines are very limited. Considering the accepted rate of progression-free survival with standard world-wide RCHOP, it seems that many patients treated in the public system do not have access to salvage treatment.

Research funding declaration: None

Keywords: Aggressive B-cell non-Hodgkin lymphoma; Cancer Health Disparities

Potential sources of conflict of interest:

D. Castro

Employment or leadership position: Employee of Hoffmann-La Roche Ltd

N. F. Correa-Netto

Employment or leadership position: Employee of Hoffmann-La Roche Ltd

C. S. K. La Scala

Employment or leadership position: Employee of Hoffmann-La Roche Ltd

I. D. Silveira

Employment or leadership position: Employee of Hoffmann-La Roche Ltd