Survivors of DLBCL Experience Higher Rates of Non-Cancer-Related Mortality

05/10/17

Although some patients with diffuse large B-cell lymphoma (DLBCL) may be cured of their disease, risk of non-cancer causes of death is elevated in comparison with the general population, according to a study published in Cancer (published online May 2, 2017; doi:10.1002/cncr.30739).

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Survival rates among patients diagnosed with DLBCL — especially advanced-stage disease — have been increasing in recent years due to advancements in immunotherapy strategies. However, patients are at risk of dying from conditions other than their malignancy, which may stem from treatment adverse events or comorbidities associated with DLBCL. Long-term outcomes for patients treated for DLBCL are still relatively unknown.

Nadia Howlader, PhD, MS, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute (Bethesda, MD), and colleagues investigated risk profiles, cure rates, and risk of death for DLBCL. The US Surveillance, Epidemiology, and End Results (SEER) program supplied population-based data from 2002 to 2012 to help researchers assess factors associated with DLBCL-specific mortality. Researchers created an epidemiologic risk profile, incorporating demographic and clinical characteristics at the time of diagnosis to stratify DLBCL cases into low-, medium-, and high-risk groups.

Using the risk profile and groupings, researchers estimated the proportion of DLBCL cases considered cured of malignancy and then assessed the risk of death from non-cancer causes among DLBCL cases in comparison with the general population.

Among 18,047 DLBCL cases, 8274 deaths were recorded, 76% of which were attributed to DLBCL and 24% of which were attributed to non-cancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60% and 36% and the estimated cure proportions were 73%, 49%, and 27%, respectively.

Mortality risks from non-cancer causes — calculated with standardized mortality ratios — were higher for certain conditions, including vascular disease, infections, gastrointestinal diseases, and blood diseases. Additionally, researchers added that mortality risks for these conditions were highest within 5 years after initial diagnosis.

Researchers concluded that while the large majority of deaths among patients with DLBCL are disease-specific, non-cancer-related mortality is at an elevated risk for these patients compared with the general population.

“Additional clinical research is needed to develop optimal treatments for DLBCL and strategies to prevent long-term relapse and treatment-related deaths,” the authors wrote. — Zachary Bessette