(065) Incidence of any Infections and SARS-COV-2 infections in Patients Receiving Treatment for Follicular Lymphoma and Diffuse Large B-Cell Lymphoma: Real-World Evidence from a Large US National Claims Database

Background: Non-Hodgkin’s lymphoma is a heterogeneous group of conditions, including the indolent subtype follicular lymphoma (FL) and the aggressive subtype diffuse large B-cell lymphoma (DLBCL). Infections associated with NHL are a major concern due to effects of the underlying disease and its treatment and have been reported to increase with increasing lines of therapy (LoT). However, the risk of infections overall and SARS-COV-2 infections specifically is not well characterized in patients who have received multiple LoTs.

Objectives: To estimate the incidence rates (IR) of infections during the COVID-19 pandemic by type, severity and LoT received in patients treated for FL or DLBCL in the real-world setting.

Methods: We identified patients in the Optum Clinformatics claims data from October 1, 2015, to June 30, 2023. Patients were aged ≥18 years, enrolled continuously for 365 days before index (start of LoT), and had ≥2 ICD-10 diagnosis codes for FL or DLBCL in the 365 days before index. The IR (per 100 person-years, PY) was estimated for infections by type (any infections and SARS-COV-2 [after 1/1/2020]), severity (hospitalized or fatal hospitalizations), and number of LoTs received.

Results: A total of 4,799, 989, and 249 FL patients were included in the 1L (1 LoT), 2L, and 3L+ cohorts, respectively. The IR of infections resulting in hospitalization in 1L, 2L, and 3L+ cohorts were 20.4 (95% confidence interval (CI): 18.9-22.1), 32.5 (27.4-38.5), and 56.7 (44.3-72.5) per 100-PY for any infection; and 9.7 (8.1-11.5), 8.5 (5.4-13.4) and 11.6 (6.2-21.5) per 100-PY for SARS-COV-2 infections, respectively. The IR of fatal hospitalizations were 4.1 (3.5-4.8), 9.3 (7.0-12.4), and 14.9 (9.8-22.8) per 100-PY for any infection; and 2.7(2.0-3.8), 3.1(1.5-6.5), and 3.4 (1.1-10.5) per 100-PY for SARS-COV-2 infections.
A total of 8,058, 2,114, and 682 DLBCL patients were included in 1L, 2L, and 3L+ cohorts, respectively. The IR of infections resulting in hospitalization in 1L, 2L, and 3L+ cohorts were 64.2 (60.7-67.8), 85.2 (76.9-94.3), and 113.4 (98.4-130.7) per 100-PY for any infection; and 13.1 (11.4-15.1), 14.4 (10.9-19.0), and 22.8 (16.7-31.0) per 100-PY for SARS-COV-2 infections respectively. The IR of fatal hospitalizations were 12.0 (10.8-13.3), 23.0 (19.5-27.1), and 27.8 (22.1-34.9) per 100-PY for any infection; and 3.1 (2.3-4.1), 5.5 (3.5-8.6), and 7.0(4.1-12.0) per 100-PY for SARS-COV-2 infections in 1L, 2L and 3L+ cohorts, respectively.

Conclusions:
This real-world analysis demonstrated substantial morbidity and mortality associated with overall and SARS-COV-2 infections among NHL patients, with a higher incidence in DLBCL compared to FL, and with increasing LoTs.