Clinical Outcomes of Patients with Newly Diagnosed Large B-Cell Lymphoma in a Safety-Net Hospital System

Real-world outcome data for patients with large B-cell lymphomas (LBCL) who are uninsured or have socioeconomic barriers to care are limited. We performed a retrospective cohort study of patients with newly diagnosed LBCL treated in a large safety-net hospital system. Between January 2011 and June 2022, 496 patients ages >18 years were diagnosed with LBCL at Harris Health System, Houston, TX. The median age was 53 years, 75% were uninsured, and 81% were in the most disadvantaged Area Deprivation Index national quartiles. Most (69%) had stage III/IV disease, 44% had poor-risk disease by the Revised International Prognostic Index (R-IPI), and 17% had a history of HIV infection. The median diagnosis-to-treatment interval was 17 days. The median follow-up time was 53.5 months. Among 464 evaluable patients, 66% achieved a complete response, and 11% had a partial response. Twenty-six (54%) of 48 patients eligible for cell therapies received them. At 5 years, event-free and overall survival (OS) rates were 57% and 68%, respectively. Factors that affected OS included Hispanic ethnicity (HR 0.70, p=0.027), R-IPI (HR 4.67 for poor- vs. very-good-risk, p<0.001), National Cancer Institute Comorbidity Index (HR 1.53 per unit increment, p=0.003), hemoglobin (HR 0.89 per unit increment, p=0.002), and International Normalized Ratio (HR 2.17 per unit increment, p=0.007). Insurance status was not associated with differences in OS. In our safety-net health system with robust financial assistance programs and limited access to cell therapies, uninsured status was not associated with inferior outcomes. Addressing barriers to care may improve outcomes in other settings.