Impact of resource availability on outcomes of diffuse large B-cell lymphoma: real-world data from Pakistan

• Patients treated in low- and middle-income countries have restricted access to detailed immunohistochemistry, FISH testing, PET scan, and rituximab. • Patients treated in resource-limited settings have inferior OS and DFS, compared to resource-enhanced settings. The purpose of this study is to assess the impact of resource availability on the outcomes of diffuse large B-cell lymphoma (DLBCL) and identify areas of improvement in managing DLBCL in resource-limited settings. This multicentric retrospective study included 756 patients across 12 public and private hematology, oncology, and hematopoietic stem cell transplant centers in Pakistan. The median age at diagnosis was 47.92 years (range, 14-89), which was higher in resource-enhanced settings than resource-limited ones ( P =.001). The male-to-female ratio was 2:1. Detailed immunohistochemistry was available for 22 patients (4.3%) in resource-limited vs 155 (59.3%) resource-enhanced settings ( P = .000). Higher International Prognostic Index scores, advanced stage, and central nervous system disease were seen in resource-limited settings ( P = .000). Computed tomography scan was the primary diagnostic modality in resource-poor settings, compared to positron emission tomography scan (64% vs 38.8%; P = .000). Complete response (CR) rate was lower for resource-limited settings (35.5% vs 54.4%; P = .000). R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) yielded a higher CR than CHOP ( P = .000). Only 10 relapsed/refractory patients (29%) in resource-limited setting received salvage treatment compared to 15 (48%) in resource-enhanced setting ( P = .02). For the entire cohort, overall survival was 40.6%, higher in resource-enhanced setting (53% vs 35.2%; P = .000). Disease-free survival was 36.3% (47% in resource-enhanced vs 31.4% in resource-limited settings; P = .000). The study highlights disparity in outcomes between patients in resource-limited vs resource-enhanced settings. Efforts are required to bridge this gap by uniform resource allocation and establishing specialized centers.