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Published on: December 28, 2015
Estimating the Proportion of Transplant-Eligible Patients in Diffuse Large B-Cell Lymphoma: Insights from German
Ann-Cathrine Froitzheim1,2, Melina Sophie Kurte1, Tabea Poos1
1VITIS Healthcare Group, Cologne, Germany.
Introduction:
Treatment, according to guidelines, for second-line and beyond (2L+) therapy of diffuse large B-cell lymphoma (DLBCL) differentiates between transplant-eligible and transplant-ineligible patients. Transplant-eligible patients typically receive salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (HD-ASCT) or chimeric antigen receptor T-cell therapy. Although literature suggests a 50-50 distribution between transplant-eligible and transplant-ineligible patients, real-world evidence from Germany is lacking. This study aimed to estimate the proportion of transplant-eligible and transplant-ineligible patients using intended-for-HD-ASCT national inpatient billing data to evaluate the validity of the commonly assumed distribution.
Methods:
Inpatient billing data from all German hospitals in 2024, provided by the Institute for the Hospital Remuneration System (InEK), were analyzed. Cases with the main diagnosis "C83.3" (DLBCL) defined the base population. Applying guideline-based first-line cure rates (60% [minimum]-70% [maximum]), the 2L population size was estimated. Transplant-eligible cases were identified via operation and procedure score codes for salvage immunochemotherapies (R-ICE, R-DHAP, R-GDP). The transplant-eligible proportion was calculated by dividing the number of transplant-eligible cases by the estimated 2L population. Sensitivity analyses were performed using data from 2022 to 2023, validating the 2L relapse/refractoriness rate assumption against German real-world claims data, and assessing potential impact of polatuzumab vedotin-related coding bias.
Results:
The base population included 32,851 DLBCL cases. Based on cure rate assumptions, the estimated 2L population size ranged from 9,855 (minimum) to 13,140 (maximum). A total of 7,523 cases were identified to have received salvage immunochemotherapy based on coding criteria. This corresponds to a transplant-eligible proportion of patients intended for HD-ASCT of 57% (minimum) and 76% (maximum). Sensitivity analyses yielded a transplant-eligible proportion range of 40-54% (2022) and 52-69% (2023), 52% when applying the relapse/refractoriness rate from German real-world claims data, and 34-46% when excluding polatuzumab vedotin-related cases.
Conclusion:
This analysis introduces a method for approximating the distribution of transplant eligibility among DLBCL patients intended for HD-ASCT in the 2L setting using real-world inpatient billing data. The results question the widely assumed balance between transplant-eligible and transplant-ineligible groups, indicating a possible tendency toward a slightly higher proportion of transplant-eligible cases which may be clinically eligible for HD-ASCT.
