OBJECTIVES: High-dose chemotherapy and autologous stem cell transplantation (ASCT) is the standard of care for 2^nd line R/R-DLBCL management. However, most of R/R patients are ASCT-ineligible. This study aimed at describing R/R-DLBCL management in ASCT-ineligible patients.

METHODS: This was a descriptive, retrospective, longitudinal study using secondary data from French hospital database (PMSI). Incident patients with R/R-DLBCL were identified over the 2017-2020 period, using validated INCa algorithm and treatment sequences. Patients with R/R-DLBCL were followed for ≥24 months or until inpatient death. Three groups were targeted: (G1) ASCT-ineligible due to age (≥70y) and/or comorbidities, (G2) post-ASCT relapse, and (G3) other ASCT-ineligible.

RESULTS: 10,087 incident R/R-DLBCL patients were identified. ASCT-ineligible patients accounted for 86.7% of R/R-DLBCL. G1, G2 and G3 accounted for 5,488, 566 and 3,257 patients, respectively. Average follow-up was 37.6 months. G1 had the highest mean age (75.3y) and comorbidity rate (32.7%). G1 median (Q1-Q3) cumulative length of stay (MCLOS) was 99.0 (56.0-167.0) days, or 66.0 (36.0-108.0) days when considering hospitalizations with overnight stay. Median (Q1-Q3) number of stays with chemotherapy was 12.0 (9.0-18.0), over a 10.1-month period between first and last therapy. Few (17.4%) patients required inter-hospital transfer and only 1.7% had CAR-T-cell therapy. Despite a younger age (56.1 years), similar trends were observed in G3, with a MCLOS of 76.0 (37.0-140.0) days, 13.0 (9.0-18.0) stays with chemotherapy, and 20.6% inter-hospital transfer rate. Patients in G2 (age: 55.6 years) had a longer MCLOS (160.0 (110.0-238.5)), a longer time between first and last treatment (32.1 months), more frequent inter-hospital referrals (44.9%) and CAR-T-cells use (12.0%).

CONCLUSIONS: This study highlights the extensive hospital management of ASCT-ineligible patients with R/R-DLBCL before 2021, and the substantial time spent in hospital, which is clinically significant notably for the older and frailer sub-population. Evolving clinical practice brings new treatments that could change these hospital patterns.