Treatment intensity, illness burden, and disparities in newly diagnosed diffuse large B-cell lymphoma treated at an urban academic center.

Dose intensity is critical in diffuse large B-cell lymphoma (DLBCL) but can be limited by toxicity risk. The influence of treatment intensity, illness burden, and socioeconomic status (SES) on survival in DLBCL has not been evaluated on a patient-level analysis. We performed a retrospective study of 344 patients with DLBCL from an urban academic cancer center; 55% received lower intensity treatment (average relative dose intensity [ARDI] of cyclophosphamide and doxorubicin <0.9). ARDI, performance status (PS), Charlson comorbidity index (CCI), and double expressor lymphoma (DEL) were associated with progression-free (PFS) and overall survival (OS). Lower ARDI was linked to worse illness burden, treatment intolerance, and higher-risk disease features. Lower ARDI was associated with worse PFS (HR 2.59, p < 0.001) and OS (HR 4.26, p < 0.001) as well as DLBCL progression (sHR 1.86 p = 0.004) and non-relapse mortality (NRM) (sHR 5.45 p = 0.001) in competing risks analysis. Comprehensive multidisciplinary care is needed to reduce the risks associated with undertreatment in DLBCL.