OBJECTIVES: Identify current DLBCL treatment adoption in Brazil and verify total cost of treatment. DLBCL is the most common subtype of non-Hodgkin lymphoma, many patients manage to live disease free for a long time, however, patients under 2^nd line of treatment have poor prognosis. According to NCCN Guidelines, tafasitamab, polatuzumab and lisocabtagene maraleucel are preferred 2^nd line treatments for DLBCL patient’s ineligible for transplantation. None of these options are registered in Brazil and only tafasitamab is in process of registration.

METHODS: Retrospective analysis of the number of diagnostics, costs, and therapies used to treat DLBCL patients (ICD-10 code C83.3), considering out and in-patient data from SUS database between March 2008 and December 2022.

RESULTS: The number of diagnostics grew between 2008 and 2015, however, it has been dropping since 2016 from 3.619 to 1.292 cases in 2022. 85% of patients went through chemotherapy. Of these, 85%, 11% and 4.4% in 1^st, 2^nd and 3^rd line, respectively. 9% of patients were treated with radiotherapy, while 13% did not receive either chemotherapy or radiotherapy. From 2016 to 2021 the cost of DLBCL treatment has increased 25%, or R$ 24 million to R$ 30 million out-patient, and 60%, or R$ 4.5 million to R$ 7.2 million in hospital. The main 1^st line regimens used were R-CHOP (79%), R-DA-EPOCH (14%) and R-CEOP (5%). And in 2^nd line R-ICE (26%), R-DHAP (25%), R-GemOx (16%), R-DA-EPOCH (11%), R-CHOP (11%) and rituximab (7%).

CONCLUSIONS: It was observed a possible underdiagnosis for DLBCL since 2016. On the other hand, the cost of treatment has progressively increased. According to the data, there is a therapeutic gap for DLBCL patients in 2^nd line of treatment and ineligible to transplantation, once no therapies designated for this indication are being used in Brazil.