Diffuse large B-cell lymphoma outcomes in an urban safety-net cohort: functional status, clinical risk, and treatment feasibility

Outcomes in diffuse large B-cell lymphoma (DLBCL) remain heterogeneous, and data from U.S. urban safety-net hospitals are limited. We conducted a retrospective cohort study of adults with newly diagnosed DLBCL treated at a single urban safety-net hospital between 2013 and 2023 to evaluate associations between functional status, clinical risk stratification, comorbidity burden, HIV status, insurance, frontline treatment feasibility, and overall survival (OS). Among 62 patients (median age 59 years; 79% Afro-Caribbean; 28% HIV-positive; 45% uninsured), the estimated one-year OS was 62% (95% CI 50-74%). Eastern Cooperative Oncology Group performance status ≥2 (hazard ratio [HR] 2.45) and a higher revised International Prognostic Index score (HR 1.75 per point) were independently associated with inferior OS. Patients managed with supportive care experienced markedly worse survival. Insurance status and cell of origin were not independently associated with OS. Survival in this safety-net DLBCL cohort was primarily driven by functional status, clinical risk, and treatment feasibility.