OUTCOMES OF DIFFUSE LARGE B CELL LYMPHOMA PATIENTS TREATED IN A BRAZILIAN PUBLIC CANCER CENTER – A REAL WORLD EXPERIENCE OF 809 PATIENTS IN A 11 YEAR PERIOD

Abstract

Introduction: Diffuse Large B Cell Lymphoma (DLBCL) is a heterogenous disease. Factors based on clinical and simple laboratory parameters are known and widely used such as the Revised International Prognostic Index (R-IPI) and National Comprehensive Cancer Network -IPI (NCCN-IPI). Thus, we aimed to report real world experience of outcomes of DLBCL lymphoma patients treated in a Brazilian public cancer institution and evaluate the prognostic role of R-IPI and NCCN-IPI. Methods: This is an unicenter registry study including DLBCL patients in a public tertiary cancer center in the São Paulo city, Brazil. All consecutive patients diagnosed between January 2009 and December 2020. Aged ≥ 18 years, treated with R-CHOP or R-CHOP like regimens were included. Patients with AIDS related lymphoma, or primary mediastinal lymphoma were excluded. Patients were stratified by R-IPI and NCCN-IPI and statistical analyses were performed. Progression free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier curve. All variables studied showed less than 10% of missing data and valid percents were reported. Results: We analyzed 809 patients who met the eligibility criteria. 416 (51.5%) were males. Median age was 59.9 (44.9 – 68.2) years, 271 (31.3%) presented ECOG ≥2, 561(74.9%) advanced disease, 695 (87.4%) elevated LDH and 638 (82.2%) extra-nodal infiltration. All cases were possible to be classified by prognostic score 465(57.5%) were classified as high risk or high-intermediate NCCN-IPI (≥ 4 pts) and 411 (50.8%) poor prognosis by R-IPI (≥ 3 pts). It was possible evaluated response status after first line treatment in 678 patients,456 (67.2%) achieved Complete Response. Four years OS and PFS for the entire patient cohort were 65.3% 95CI (61.5-68.9) and 60.4% 95CI (56.5-64.), respectively. Median follow-up 4.6 95CI (4.2-5.0) years. Patients classified as very good (0), good (1-2) and poor (≥ 3) prognosis by R-IPI presented 4-years OS 94%, 75.2% and 52.8%, p < 0.0001. About 4-years PFS: 94%, 68.8%, 48.2%, p < 0.001, respectively. According to NCCN-IPI and risk group: low (0-1), low-intermediate (2-3), high-intermediate (4-5) and high risk 4 years OS: 95.5%, 75.4%, 60.3%, 35.9%, p < 0.0001) and 4-years PFS: 93.7%, 69.7%, 54.7% and 33.3%, p < 0.001, respectively. Conclusion: In this large cohort of DLBCL patients diagnosed and treated in a public University center in Brazil, we have observed a higher frequency of patients with unfavorable prognosis 57.5% NCCN IPI (≥4 pts) and 50.8% R IPI (≥3 pts) when compared to data published in the literature 39% and 45%, respectively. OS and PFS are comparable to data of literature according to NCCN IPI and R IPI scores. Both scores discriminate groups of patients with DLBCL in a middleincome country and may be used to study further strategies to improve outcomes of patients with poor prognosis.