Racial, ethnic disparities in mortality risk shown among younger patients with DLBCL
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Key takeaways:
- All groups in the study had significantly higher mortality risk compared with white patients.
- Incidence of DLBCL among non-Hispanic Asian/Pacific Islander patients increased throughout the study period.
SAN DIEGO — Significant racial and ethnic disparities exist in survival outcomes of adolescent and young adults with diffuse large B-cell lymphoma, according to study findings presented at ASH Annual Meeting and Exposition.
Decreases in the incidence of DLBCL occurred among most of the study’s cohorts, with only patients who identified as non-Hispanic Asian/Pacific Islander experiencing an increase in DLBCL incidence over the two decades examined in the analysis.
“The decrease in overall incidence didn’t surprise me; however, the differences between the racial groups were pretty significant,” Mustafa Wasifuddin, MD, an internal medicine resident physician at Brookdale University Hospital and Medical Center, told Healio. “Especially with the Black patient population showing the highest decrease — I wasn’t expecting that at all, nor did I expect that the white patient population would have the smallest decrease,” he added. “The most significant part of this research is that the Asian/Pacific Islander patient population saw the only increase — and a pretty big one, too — which caused me to take a look at different studies across China, Japan and South Korea, which were all reporting pretty similar results for DLBCL.”
Background and methodology
Wasifuddin and colleagues conducted a retrospective study to evaluate the potential influence of race on both the incidence and survival outcomes among adolescents and young and adults with DLBCL.
Researchers utilized data from the SEER 17 Research Plus database program to obtain the annual percentage change (APC) in incidence of patients with DLBCL between 2000 and 2020 in the adolescent and young adult cohort (aged between 15 and 39 years).
They used the Kaplan-Meier method to determine OS and cancer-specific survival, and Cox regression analysis to determine predictors of survival.
Study investigators identified 8,735 patients (median age, 31 years; 59% men) diagnosed with DLBCL to be included in the study analysis.
Results, next steps
The analysis showed the proportion of adolescents and young adults with DLBCL decreased the most among patients who identified as non-Hispanic Black (45% vs. 55%) and non-Hispanic white (45% vs. 55%) — with non-Hispanic American Indian/Alaska Natives (48% vs. 52%) also showing a noticeable decrease — over the 2-decade study period.
Researchers noted no statistical difference in the Hispanic group, while the proportion of patients with DLBCL increased significantly among patients who identified as non-Hispanic Asian/Pacific Islander (58% from 2011-2020 vs. 42% from 2000-2010).
During the 2-decade study period, researchers observed a significant decrease in yearly incidence of DLBCL among the overall adolescent and young adult cohort (APC = 0.05%), which appeared most prevalent in patients who identified as non-Hispanic Black (APC = 1.4%), Hispanic (APC = 0.65%) and non-Hispanic white (APC = 0.57%). Conversely, an APC of 1.88% occurred in the incidence of DLBCL among patients who identified as non-Hispanic Asian/Pacific Islander.
Further analysis showed median OS of 58 months (95% CI, 21–147) among non-Hispanic American Indian/Alaska Native patients, 63 months (95% CI, 19–139) among non-Hispanic Asian/Pacific Islander patients, 63 months (95% CI, 13–142) among non-Hispanic Black patients), 58 months (95% CI, 14– 134) among Hispanic patients and 98 months (95% CI, 31–172) among non-Hispanic white patients.
The investigators also noted 5- and 10-year cancer-specific survival rates of 86.5% and 85.4% for non-Hispanic white patients; 85.4% and 84.4% for non-Hispanic Asian/Pacific Islander patients; 81.3% and 80.3% for Hispanic patients; 68.1% and 68.1% for non-Hispanic American Indian/Alaska Native patients; and 71.9% and 69.4% for non-Hispanic Black patients.
Patients who identified as non-Hispanic Black (HR = 1.91; 95% CI, 1.7–2.15), non-Hispanic American Indian/Alaska Native (HR = 2.09; 95% CI, 1.29–3.38) and Hispanic (HR = 1.35; 95% CI, 1.2–1.53) had significantly higher mortality risk compared with non-Hispanic white patients.
Due to the significant increase in DLBCL incidence among patients in the Asian/Pacific Islander cohort, Wasifuddin said he hopes to further investigate outcomes among this group moving forward.
“For other lymphomas, incidence [for that specific cohort] is decreasing, even among patients with solid tumors, but only is the incidence going up for non-Hodgin lymphoma and specifically DLBCL,” Wasifuddin told Healio.
“None of the studies that I looked at after seeing our data really explored reasons as to why this is happening, so hopefully my next project will be trying to figure out exactly why,” he added. “One factor I’ve looked into is that Epstein-Barr virus, which can contribute to development of DLBCL, is common among the Asian/Pacific Islander group — so that could be one explanation, but I don’t believe that can be the full explanation for such an increase.”
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Wasifuddin M, et al. Abstract 384. Presented at: ASH Annual Meeting and Exhibition; Dec. 9-12, 2023; San Diego.
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