Patients with diffuse large B cell lymphoma (DLBCL) are at an elevated mortality risk from non-cancer causes even after the disease is cured, according to a study published in Cancer.1
The incorporation of rituximab into standard treatment regimens for DLBCL has improved long-term survival and cure rates. Patients are, however, at risk of death from factors other than this malignancy, including treatment-related side effects and disease-induced immunosuppression.
For this study, researchers evaluated data from the US Surveillance, Epidemiology, and End Results (SEER) program to determine cancer-specific and non-cancer-related mortality rates among patients diagnosed after the introduction of rituximab in 2002.
Risk profiles were developed using clinical and demographic data; patients were grouped into low-, medium-, and high-risk groups. Standardized mortality ratios (SMRs) were used to compare mortality rates among patients with those of the general population.
The 18,047 patients included were divided into 1 of the 3 risk tertiles based on age, disease stage at diagnosis, ethnicity, gender, and sociodemographic data. The strongest independent risk factors were age and disease stage at diagnosis.
Patients in the low-, medium-, and high-risk groups had cure proportions of 73%, 49%, and 27%, respectively, though the authors noted some uncertainty in these figures.
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Patients with DLBCL were also at an increased risk of non-cancer-related deaths from blood disease, infection, gastrointestinal disease, vascular diseases, and lung disease. SMRs in between 0 and 59 months post-diagnosis were particularly high; after 59 months these risks were lower, though not non-existent.
The highest SMR was for blood disease in between 0 and 59 months post-diagnosis.
The authors concluded that even after the introduction of rituximab, patients diagnosed with DLBCL are at an elevated risk of death from non-cancer causes. They also noted that DLBCL-specific mortality is still a risk for patients even after 2-year survival is reached.
- Howlader N, Mariotto AB, Besson C, et al. Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era. Cancer. 2017 May 2. doi: 10.1002/cncr.30739 [Epub ahead of print]