Disparities in the long-term survival of adolescent and young adult diffuse large B cell lymphoma survivors

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Introduction

Each year there are approximately 90,000 new cancer diagnoses in the adolescent and young adult (AYA, ages 15–39 years) population in the United States and cancer incidence in this group has risen by about 30% over the past four decades [12] . Accompanying this increase has been an improvement in 5-year mortality to > 80% [34] , leading to a growing population of survivors of AYA cancer. As the population of survivors grows, more data on long-term outcomes is needed. Compared with knowledge of long-term outcomes in the childhood cancer population [5] , data in the AYA survivor population is lacking. Prior studies have reported that long-term survival in AYA cancer survivors is compromised compared with the general population 6789 .

Socioeconomic status (SES), rurality, race and ethnicity are known to impact 5-year survival in AYA cancer patients, with low SES neighborhood, rural area residence, and Black race associated with worse 5-year survival compared with high SES neighborhood metropolitan residence, and White race, respectively 1011121314 . Initial studies have shown these factors can also impact longer-term survival. There is evidence that racial disparities in survival persist at up to 10 years of follow-up [1516] , and a single institution study has found that low SES markers are associated with inferior survival at up to 15 years of follow-up in AYA cancer survivors [17] . Among 5-year AYA Hodgkin lymphoma survivors, race and SES have been found to impact survival at up to 30 years of follow-up [18] . Additional studies are needed assessing long-term survival disparities in other common AYA cancer types.

Diffuse large B cell lymphoma (DLBCL), is the most common subtype of non-Hodgkin lymphoma (NHL) and the most common lymphoid malignancy after classical Hodgkin lymphoma (HL) in the AYA population [19] . With treatment advances such as the addition of rituximab therapy, 5-year survival of AYA DLBCL has improved to about 80% in recent years [20] . To date, data on racial/ethnic and SES disparities in AYA DLBCL survival are sparse and even less is known about long-term mortality disparities. With incidence increases of NHL among AYAs outpacing the increased incidence of cancer in general in this population [2] , knowledge of long-term mortality disparities is important to guide survivorship care. Utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database, the current retrospective analysis sought to characterize long-term mortality outcomes over time among 5-year survivors of AYA DLBCL, with a focus on race/ethnicity, SES, rurality, diagnosis age, sex, and disease stage at diagnosis.