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DLBCL is the most common histologic subtype of non-Hodgkin lymphoma. Treatment guidelines recommend rituximab in combination with chemotherapy as first-line therapy (1LT). For patients who are refractory or relapse, high-dose chemotherapy with stem cell transplant, combination chemotherapy, or single-agent rituximab are recommended in subsequent lines.

The Optum claims database was used to identify adult patients (≥18 years old) with newly diagnosed DLBCL between 01/01/08 and 10/31/15. DLBCL diagnosis was based on ≥1 inpatient claim or ≥2 outpatient claims with DLBCL diagnosis codes, with the index date being the first DLBCL claim. Patients were followed from index date until end of continuous enrollment, death, or end of study period (12/31/15). Treatment patterns and response to treatment were assessed during follow-up. Possible remission was defined as no additional chemotherapy and no supportive care use or receipt of supportive care <30 days after end of line of therapy (LOT) for <30 days. Lack of remission was defined as receipt of supportive care <30 days after end of LOT for >30 days. Progression was defined as initiation of another LOT or evidence of supportive care >30 days after end of a LOT.

Of the 2,216 patients selected into the study, 1,267 (57.2%) initiated 1LT, and median (interquartile range [IQR]) time to therapy was 0.7 (0.4–1.1) months. The majority of patients received combination (87.7%) vs single-agent (12.3%) chemotherapy. R-CHOP (60.5%) was the most frequently used combination chemotherapy, while rituximab monotherapy comprised ~67% (8.2%) of single-agent use in 1LT. Median (IQR) duration of 1LT was 4.2 (2.3–4.5) months. At the end of 1LT, 64.0% (n=811) had evidence of remission, 15.0% (n=190) progressed, and 1.2% (n=15) had no evidence of remission. Second-line therapy (2LT) was initiated by 159 patients who progressed after 1LT; 29.6% received a single agent, and 70.4% received combination chemotherapy. In 2LT, rituximab (12.6%) remained the top single agent used, while bendamustine+rituximab (15.7%) and R-CHOP (8.2%) were the most common combinations; 8.2% of patients received stem cell transplant. Median (IQR) duration of 2LT was 2.1 (1.2–3.8) months. Of the 2LT patients, 44.0% (n=70) had evidence of remission, 26.4% (n=42) progressed, and 3.1% (n=5) had no evidence of remission. 34 patients who progressed after 2LT received third-line therapy (3LT); 29.4% received a single agent, while 70.6% received combination chemotherapy. In 3LT, rituximab (5.9%), etoposide (5.9%), and carboplatin (5.9%) were the most common single agents, while bendamustine+rituximab (20.8%) and etoposide+oxaliplatin+rituximab (17.6%) were the most common combinations; 8.8% of patients received stem cell transplant. Median (IQR) duration of 3LT was 3.5 (0.9–5.2) months. Following 3LT, 32.4% (n=11) had evidence of remission, 29.4% (n=10) progressed, and 5.9% (n=2) had no evidence of remission.

DLBCL treatment in routine clinical care aligns with guidelines, with most patients receiving rituximab in combination with chemotherapy. A small proportion of patients received single-agent chemotherapy in 1LT. As expected, remission rates decreased with subsequent lines of therapy. Some patients were untreated; therefore, subsequent studies should explore reasons for lack of treatment.