Examining racial differences in diffuse large B-cell lymphoma presentation and survival

• Authors: Christopher R Flowers, Emory University; Pareen J. Shenoy, Emory University; Uma Borate, University of Alabama Birmingham; Kevin Bumpers, Emory University; Tanyanika Douglas-Holland, Emory University; Nassoma King, Emory University; Otis W Brawley, Emory University; Joseph Lipscomb, Emory University; Mary Jo Lechowicz, Emory University; Rajni Sinha, Emory University; Rajinder S. Grover, Emory University; Leon Bernal-Mizrachi, Emory University; Jeanne Kowalski, Emory University; Will Donnellan, University of Alabama Birmingham; Angelina The, University of Alabama Birmingham; Vishnu Reddy, University of Alabama Birmingham; David L Jaye, Emory University; James Foran, University of Alabama Birmingham
• Journal Title: Leukemia & Lymphoma
• Volume: Volume 54, Number 2
• Publisher: Taylor & Francis: STM, Behavioural Science and Public Health Titles | 2013-02-01, Pages 268-276
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.3109/10428194.2012.708751
• Subjects: Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Hematology; Diffuse large B-cell lymphoma; race; disparities; outcomes; CHOP regimen; R-CHOP regimen; NON-HODGKINS-LYMPHOMA; EPIDEMIOLOGY CONSORTIUM INTERLYMPH; ANTI-CD20 MONOCLONAL-ANTIBODY; CHEMOTHERAPY PLUS RITUXIMAB; FC-GAMMA-RIIIA; ELDERLY-PATIENTS; CANCER STATISTICS; UNITED-STATES; CHOP; CLASSIFICATION

Abstract

We performed a retrospective cohort analysis of 701 (533 white and 144 black) patients with diffuse large B-cell lymphoma (DLBCL) treated at two referral centers in southern United States between 1981 and 2010. Median age of diagnosis for blacks was 50 years vs. 57 years for whites (p < 0.001). A greater percentage of blacks presented with elevated lactate dehydrogenase levels, B-symptoms and performance status ≥ 2. More whites (8%) than blacks (3%) had a positive family history of lymphoma (p = 0.048). There were no racial differences in the use of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; 52% black vs. 47% white, p = 0.73). While black race predicted worse survival among patients treated with CHOP (hazard ratio [HR] 1.8, p < 0.001), treatment with R-CHOP was associated with improved survival irrespective of race (HR 0.61, p = 0.01). Future studies should examine biological differences that may underlie the observed racial differences in presentation and outcome.