DISPARITIES IN ACCESS TO BIOLOGICAL MARKERS FOR NHL IN BRAZIL

Non-Hodgkin lymphoma (NHL) is a group of heterogeneous diseases with diverse mechanisms, biological markers, and clinical presentations. About 85% of NHL cases are B-cell-derived, predominantly diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). NHL subtypes are classified using clinical findings, morphology, immunohistochemistry (IHC), immunophenotyping, and genetics. FL shows BCL-2 overexpression, mantle cell lymphoma (MCL) involves the t(11;14) leading to cyclin D1 overexpression, and DLBCL can be further divided into GCB-like and ABC-like using IHC markers CD10, BCL6, and IRF4/MUM1. Although biological markers play a crucial role in the classification of NHL, access to IHC testing remains uneven across healthcare systems such as Brazil’s, largely due to socioeconomic and regional disparities. This study examines these disparities and their impact on NHL patient care. A cross-sectional study using an online form assessed disparities in the NHL patient journey in Brazil’s public and private healthcare sectors. Out of 49 questions, 12 focused on accessing common NHL biological markers. The survey, completed by 153 hematologists, highlighted disparities in IHC marker access. In public healthcare, 70% reported Ki67 availability and testing; 92% in private care reported consistent testing. For Cyclin D1, 63% in public settings reported testing availability, compared to 93% in private care. Ki67 and Cyclin D1 testing were absent in 6% and 8.5% of public facilities, respectively. Regarding TP53, 30% of public respondents lacked access to IHC, and 36% to molecular tests. Conversely, 43% in private settings used IHC, 22.5% combined it with molecular biology, and 5% lacked IHC access. Over 50% in both settings reported BCL-2 and MYC IHC access; 35% in private care used FISH. Notably, 5% and 14% in public facilities lacked BCL-2 and MYC IHC access. The Hans algorithm was consistently used by 79.5% in private and 64% in public sectors for DLBCL classification. Interestingly, 50% across both sectors sought second opinions on pathology reports due to report accuracy concerns. Significant disparities in IHC marker access exist between Brazil’s public and private healthcare systems, impacting NHL classification and treatment. Addressing these inequalities is crucial for improving outcomes and ensuring equitable healthcare access.