OBJECTIVES: To examine real-world treatment patterns, healthcare resource utilization and costs among third-line (3L) relapsed and refractory (R/R) diffuse large B-cell lymphoma (DLBCL) patients in the United States.

METHODS: A retrospective claims analysis was carried out using the IBM^® MarketScan^® Database (Jan 2015-Dec 2019) to assess treatment patterns and costs among adult DLBCL patients receiving 3L treatment. A diagnosis of DLBCL (ICD10 C83.X), > 12 months pre-diagnosis baseline data with no anti-cancer treatments or other primary cancers, and >3 months follow-up data were required for inclusion. Treatments received in 3L, time to next therapy (TTNT) and % receiving subsequent treatments are described. Healthcare resource utilization (HCRU) and costs while on treatment are reported on a per patient per month (PPPM) basis.

RESULTS: A total of 133 3L DLBCL patients met inclusion criteria with a median follow-up of 5.7 months. Median [IQR] patient age was 57 [50, 62] years and 59% were male. Commonly received 3L therapies were chemotherapy combination/monotherapy (20%), autologous stem cell transplant (20%), rituximab containing therapies (17%), radiotherapy combination (11%) and a multitude of other treatments and combinations. Median TTNT was 4.4 months and 30% of patients received a 4L, though the follow-up period was limited. As patients advanced from 1L to 3L, the proportion of patients with inpatient stays increased (32% to 43%, respectively). Median PPPM costs more than doubled from 1L to 3L, increasing as patients advance through lines of therapy with $33,669 PPPM in 1L, $39,300 in 2L and $72,224 in 3L. Costs were largely driven by inpatient and other medical costs.

CONCLUSIONS: Treatment options in 3L R/R DLBCL are heterogenous with no clear standard of care. As patients advanced to later lines, inpatient stays and PPPM costs increased, underscoring the need for novel therapies to improve care for R/R DLBCL patients.