OBJECTIVES: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. Whilst R-CHOP chemotherapy results in a cure for many, high dose chemotherapy followed by haematopoietic stem cell transplantation (HSCT) can result in cure amongst the 30-45% with refractory or relapsed disease. We assessed the probability of receiving HSCT using a representative cohort of DLBCL patients in England.

METHODS: Patients with DLBCL in the National Cancer Registry for England diagnosed between 01/01/2012 and 31/12/2018 were included. Patients were followed from diagnosis until the earliest of death or end of the study. HSCT was identified using linked Hospital Episode Statistics data. We conducted nearest neighbor propensity score matching on age and cancer stage between patients with and without HSCT (1:2 ratio). We then conducted univariable and multivariable conditional logistic regression to estimate the odds of receiving HSCT by sex, ethnicity, and deprivation.

RESULTS: We included 12,982 patients with DLBCL, of whom, 1,592 had HSCT and were matched to 3,184 without HSCT. Mean age (standard deviation) was 55 (11), and 53% were diagnosed at stage IV. The odds of HSCT were significantly lower in females than males (adjusted odds ratio [aOR] 0.77, 95% CI 0.68-0.88, p<0.001) and people of black ethnicity (aOR 0.51, 95% CI 0.33-0.80, p=0.004) compared to white. By deprivation quintile, the odds of HSCT decreased with increasing deprivation (p<0.001), with an aOR of 0.60 (95% CI 0.49-0.74) in the most deprived quintile compared to the least deprived quintile.

CONCLUSIONS: Individuals with DLBCL who are female, from an ethnic minority, and who experience deprivation are less likely to receive an HSCT. HSCT comes with a significant burden to patients who are often required to isolate pre- and post-transplantation. The differences in odds of receiving HSCT by sex, ethnicity, and deprivation may reflect financial and social barriers to accessing HSCT.