Outcome of Diffuse Large B Cell Lymphoma in the VA Health System: Do We Need To Do Better?.

Background: Diffuse Large B cell lymphoma (DLBCL) is the commonest subtype of non-Hodgkin Lymphoma (NHL). Data on outcome of DLBCL in large cohorts of patients or community practices outside clinical trials are lacking. Treatment and outcomes of DLBCL among the VA patients have not been reported previously. We utilized the VA Central Cancer Registry to study cases of DLBCL in the VA system.

Methods: This was a retrospective analysis. The VA Central Cancer Registry (VACCR) database was used to identify patients with DLBCL diagnosed between 1995 and 2005. There are approximately 120 VA medical centers diagnosing and/or treating patients with cancer. The VACCR aggregates the data collected by the medical centers’ cancer registries. Data were extrapolated and analyzed using bio-statistical software SPSS. Variables included age, sex, stage of disease, histology subtype, date of diagnosis, date of last contact, date of relapse, vital status, whether patients received chemotherapy and or radiation.

Results: There were 2792 patients with DLBCL at the VACCR between 1995 and 2005, 2402 were white, 323 black patients, and 67 patients from other racial groups. The mean age at diagnosis was to 65. Majority were males (2721 patients). More patients were diagnosed at advanced stage (stage III and IV) (40%), in 34% of cases stage was not known or missing. IPI score data were not available. Most patients received multi-agent chemotherapy 70%, and 20% of patients received radiation (31 % in early stage and 12% in late stage). The 5-year overall survival was 28%. 5 year OS was 41% for stage I, 32% for stage II, 25% for stage III and 17% for stage IV. Using Cox regression multivariable analysis age and use of mutli-agent chemotherapy were the only statistically significant independent variables affecting survival.

Conclusions: Outcome of DLBCL in VA patients seems inferior to what is reported in clinical studies. The age of patients treated in the VA as well as sex could be factors affecting the outcome. There are no data available on outcome of DLBCL in such large cohort of patients outside context of clinical trials to make meaningful comparisons.