New data suggests that older patients with Diffuse Large B-cell Lymphoma (DLBCL) may experience improved outcomes when treatment is initiated later rather than immediately following diagnosis. The findings, set to be presented at the 66th American Society of Hematology (ASH) Annual Meeting, challenge the conventional approach of immediate intervention and highlight the complexities of managing DLBCL in older adults.
The real-world data (RWD) study, conducted by COTA in partnership with the Memorial Sloan Kettering Cancer Center (MSK), analyzed DLBCL patient outcomes based on the time interval between diagnosis and the start of first-line therapy. The research revealed that patients who began treatment within the first or second week after diagnosis had shorter median times to requiring next-line therapy and lower overall survival rates compared to those with a longer diagnosis-to-treatment interval (DTI).
Impact of Diagnosis-to-Treatment Interval
The study, titled "Impact of the Diagnosis-to-Treatment Interval (DTI) on Outcomes in Older Adults with Diffuse Large B-Cell Lymphoma Treated in the Real-World Setting," emphasizes the significance of DTI in older DLBCL patients. These patients, often underrepresented in clinical trials, may benefit from a more nuanced approach to treatment initiation.
Patient Characteristics and Treatment Centers
Further analysis indicated that patients who initiated treatment sooner were more likely to have been treated in academic medical centers and had higher Eastern Cooperative Oncology Group (ECOG) scores, reflecting a poorer overall well-being. These patients also presented with high-risk clinical features, including bulky disease or activated B-cell (ABC) subtypes of DLBCL.
Expert Commentary
Paul Hamlin, medical director at the David H. Koch Center for Cancer Care, noted the value of real-world data in assessing outcomes in older patients. "The incorporation of real-world data to assess outcomes in older patients is an invaluable resource, given their general decreased representation in clinical trials. The data being presented at ASH 2024 regarding the DTI interval (Diagnosis to Treatment Interval) and the utilization of hospice/palliative care referrals can help inform future trials and identify ongoing gaps in our knowledge/practices."
The study's emphasis on data from community care sites, comprising over 85% of the study data, further strengthens its applicability to real-world clinical practice. These findings may prompt a re-evaluation of treatment strategies for older DLBCL patients, considering the potential benefits of a delayed treatment approach in certain cases.
