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Title: Outcome of patients with newly diagnosed diffuse large B-cell non-Hodgkin lymphomas (DLBCL) that are receiving upfront therapy in the hospital setting compared with patients diagnosed and treated in the outpatient setting
Authors: Shaffer, Seth
Supervisor: Dr. Morel Rubinger (Internal Medicine).
Examining Committee: Medicine
Graduation Date: October 2011
Keywords: medicine
Issue Date: 12-Mar-2012
Abstract: Study Aim: To establish the characteristics of patients with DLBCL that requires up-front in-hospital therapy, as well as their outcome post-therapy. Comparison of characteristics and outcomes with a concurrent cohort of outpatient managed group was made. Methods: Retrospective chart review over 5 years for newly diagnosed patients with DLBCL admitted to a teaching hospital and concurrently for patients that were managed as outpatients. The study included 46 in-patients and 96 outpatients. Patients considered eligible for R-CHOP were those from age 18-80, as patients above age 81 were initially not eligible to receive Rituximab. Results: There were 38 in-patients eligible to receive R-CHOP, with 28 receiving R-CHOP, 3 R-CVP and 7 palliation. There were 77 outpatients eligible to receive R-CHOP, with 64 receiving R-CHOP, 12 R-CVP and 1 palliation. Patients with higher IPI (3 or more) correlated with a higher need for hospitalization (p<0.001). Patients from rural setting were also more likely to be hospitalized (p=0.043). Overall survival post-diagnosis for patients eligible to receive R-CHOP was lower for in-patients compared to the outpatient group (p=0.0002). At 3 years the overall survival was 60.5% for in-patients and 77.7% for outpatients. There was no significant difference in survival between in-patients and outpatients that completed R-CHOP treatment (p=0.1120). For patients with IPI of 3 or higher that completed therapy no significant difference in survival between treatment groups was noted (p=0.53). Conclusions: In-hospital patients with DLBCL eligible to receive R-CHOP had inferior outcomes compared with the outpatient group. Comparing patients that completed chemotherapy from either group, no survival differences were seen. Same applies to patients that finish therapy and have high IPI. Ability to complete R-CHOP chemotherapy in due time led to similar outcomes for either group.
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