Predicting Outcomes in Patients With Diffuse Large B-Cell Lymphoma Treated With Standard of Care

Abstract

In diffuse large B-cell lymphoma (DLBCL), predictive modeling may contribute to targeted drug development by enrichment of the study populations enrolled in clinical trials of DLBCL investigational drugs to include patients with lower likelihood of responding to standard of care. In clinical practice, predictive modeling has the potential to optimize therapy choices in DLBCL. The objectives of this study were to create a model for predicting health outcomes in patients with DLBCL treated with standard of care and determine informative predictors of health outcomes for patients with DLBCL. This was a retrospective observational study using data extracted from the IMS Health Database between September 2007 and April 2015. Patients were ⩾18 years of age with a DLBCL diagnosis. The index date was the date of the first DLBCL diagnosis. Patients were followed until outcome occurrence, defined as progression to a later line of therapy after ⩾60 days from the end of a previous therapy or stem cell transplantation. Patients were categorized into three cohorts depending on the post-index observation period: ⩽1 year, ⩽3 years, or ⩽5 years. Lasso logistic regression (LASSO), Naive Bayes, gradient-boosting machine (GBM), random forest (RF), and neural network models were performed for each cohort. The best-performing algorithms were predictive models based on GBM and observation periods ⩽1 and ⩽3 years after index date. Informative predictors included myocardial imaging, DLBCL stage IV, bronchiolar and renal disease, a chemotherapy regimen, and exposure to diphenhydramine and vasoprotectives on or before the first DLBCL diagnosis. These predictive models may be applied to targeted drug development and have the potential to optimize therapy choices in DLBCL. They were generated efficiently using a large number of independent variables readily available in standard insurance claims or electronic health record data systems.