PRIMARY EXTRANODAL LYMPHOMA EFFORT (PELÉ): COMPARISON OF PUBLIC AND PRIVATE HEALTH CARE ASSISTANCE, FROM A BRAZILIAN MULTICENTER OBSERVATIONAL STUDY

Abstract

Objective: Compare public healthcare (Pub) with private healthcare (Pri) in Brazilian patients with primary extranodal lymphoma. Methods: PELÉ is a multicenter study that aimed to collect data from patients with B cell primary extranodal lymphoma (PEL), in several hematological reference centers in Brazil. The study design is ambispective, with the data presented here from the retrospective cohort. This cohort is still collecting data, with several other centers awaiting ethics committee approval. In the present study we evaluate patients from 7 centers located in 4 different states of Brazil. Four centers are private hospitals (Pri) and 3 are public/academic centers (Pub). Cases were collected from the last 15 years (2009 to 2024). Results: We evaluated 134 patients, with 96 treated in Pub and 38 in Pri. Median follow up was 29.7 (1.31-194.1) months. Most patients were male (Pub = 57% and Pri = 58%) and the majority of Pub (64.6%) and Pri (44.7%) identified as white, given that 47.4% of Pri did not declare their skin color. The median age at diagnosis was 61 years, equal between groups, with minimum and maximum of 22-89 years (Pub) and 24-90 years (Pri). Time between the onset of symptoms and lymphoma diagnosis was 5 months (Pub) and 3 months (Pri). There was a statistically significant difference for B symptoms (13% of Pub patients and 77% of Pri patients, p = 0.005) and the International Prognostic Index (IPI) (Pub with a higher proportion of patients with high risk, p = 0.008). Among the histological types of lymphoma, 67% of Pub cases and 100% of Pri cases were diffuse large B-cell lymphoma (DLBCL). The other Pub cases were mostly marginal zone lymphoma. The stomach was the main affected organ, similarly, affecting patients treated in Pub (29.2%) and Pri (31.6%), followed by the large and small intestine (Pub = 10.4% and Pri = 15.8%). For the Gastric lymphomas, staged according to Lugano gastrointestinal tract classification, there was no significant difference between Pub and Pri concerning clinical characteristics. In non-gastric lymphomas, there was also no significant difference in the Lugano Clinical Stage for extranodal lymphomas between Pub and Pri. The two main treatments used were R-CHOP (Pub = 60.4% and Pri = 71%) and R-miniCHOP (Pub = 9.4% and Pri = 10.5%). Complete remission (CR) was achieved in 61% of cases in Pub and 88.6% of cases in Pri. Relapses occurred in 8.5% of cases in Pub and 11.4% in Pri, while 6.1% of patients in Pub died, with no deaths recorded in Pri during the study period. Within the study observational period, the progression-free survival (PFS) was Pub = 62% and Pri = 75% (p = 0.48), and the overall survival (OS) was Pub = 74% and Pri = 92% (p = 0.079). Conclusion: PELÉ is the first study to evaluate, in a multicenter design, Brazilian patients with PEL and compare public and private healthcare assistance outcomes. There was a tendency for worse overall survival for patients in Pub versus Pri, but it was not statistically significant. Epidemiological data were generally similar, with a higher number of cases with high risk by IPI in the Pub group and B symptoms in the Pri patients. Patients in the Pri group had higher CR rate and shorter time from initiation of symptoms to diagnosis. This study has limitations such as the retrospective design and a small number of patients. Nonetheless, we believe this data is important for better understanding the outcomes of Brazilian patients with PEL in different healthcare settings.