Investigating Patients with Diffuse Large B-Cell Lymphoma Not Undergoing Stem Cell Transplant

Diffuse large B-cell lymphomas (DLBCL) are frequently cured after first-line treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). In patients who fail R-CHOP, autologous stem cell transplantation can be an effective second-line therapy. For patients who are transplant-ineligible (TNE), however, additional treatment options are limited. In a study, presented at AMCP 2022, lead author, T. Acheampong, MPH, PhD, and colleagues examined TNE patients and found burdensome health care resource utilization (HCRU) and total cost of care per patient per year (PPPY).

Dr. Acheampong and colleagues proposed that long hospitalization periods and frequent outpatient visits were driving this effect. Their analysis was based on retrospective data from the IBM Market Scan Commercial, Medicare Supplemental, and Medicaid databases.

Patients eligible for inclusion in the study had ≥1 inpatient or ≥2 outpatient DLBCL claims with available individual data for ≥12 months before and ≥6 months after indexing in 2018, 2019, or 2020. Researchers collected patient characteristics and treatment patterns in guideline-recommended therapies, including skin-directed therapy (SDT), systemic therapy, and bone marrow transplant. Quarterly data was also reviewed to assess any impact from COVID-19.

The study reviewed 10,527, 10,078, and 9,414 patients with mycosis fungoides (MF) in 2018, 2019, and 2020, respectively. The investigators observed that, “overall, 52% of MF patients had SDT each year, with increased topical (40.4% to 43.5%) but decreased phototherapy (2018: 16.2%, 2020: 12.8%) usage.” Systemic therapy use increased from 12.6% to 13.5% over the three years, with the most commonly prescribed systemic therapies being methotrexate, bexarotene, and brentuximab. Additionally, mogamulizumab, approved in 2018, was the third most common parenteral systemic therapy in 2019 and 2020. Quarter to quarter analysis identified a “decreasing trend in SDT (including phototherapy) claims from Q1 to Q4 within each year, with a notable dip in Q2 2020.” Meanwhile, quarterly utilization of parenteral and oral systemic therapies was stable across the three years.

Dr. Acheampong and colleagues deemed that SDT was the most used therapy across the three years, but may have been affected by the onset of the pandemic given the corresponding marked decrease in use. Overall, the investigators proposed that, “despite recent treatment advancements for TNE patients with DLBCL, there is a need for additional effective therapies to reduce clinical and economic burden in this population.”