{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T06:55:14Z","timestamp":1773471314392,"version":"3.50.1"},"reference-count":33,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"10","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> To highlight challenges and cancer care disparities in patients of diffuse large B-cell lymphoma management in resource-constrained settings. <\/jats:p><\/jats:sec><jats:sec><jats:title>MATERIALS AND METHODS<\/jats:title><jats:p> This multicenter retrospective study included 738 patients from 12 public and private sector hematology-oncology centers across Pakistan. Patients were divided into limited-resource and enhanced-resource settings as per national diffuse large B-cell lymphoma (DLBCL) guidelines. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> The median age at diagnosis was 47 years (range, 14-89). Male:female ratio was 2.5:1. Majority of the patients (69.3%) were treated in limited-resource settings. Computed tomography was used as a staging modality in 442 (60%) patients. Limited-stage DLBCL was present in 13.5% of patients, while 86.3% had advanced-stage disease at diagnosis. First-line regimens included rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in 56% and cyclophosphamide, doxorubicin, vincristine, prednisone in 34% of patients, while 10% of patients received palliative regimens upfront. Of evaluable data, complete remission was documented in 299 (74.4%) patients, 39 (9.8%) had partial response and 63 (13.5%) had progressive disease. Disease-free survival (DFS) and overall survival (OS) status were not available for 345 (46.8%) patients at the time of data collection. Overall study cohort had a median follow-up of 2.2 years with a median OS of 3.6 years (95% CI, 3.1 to 4.1), median DFS of 3.1 years (95% CI, 2.6 to 3.6), and a 5-year OS of 40% and DFS of 36%. <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> Patients from low- and middle-income countries present at an earlier age and have more advanced disease. Patients were frequently lost to follow-up, and record keeping was inadequate more so in patients treated in limited-resource settings. There is a need to establish a national lymphoma registry, improve record keeping, and standardize treatments to ensure improvement in treatment outcomes. <\/jats:p><\/jats:sec>","DOI":"10.1200\/go.23.00386","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T19:59:28Z","timestamp":1712865568000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Real-World Challenges of Managing Diffuse Large B-Cell Lymphoma in a Developing Country"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8767-3491","authenticated-orcid":true,"given":"Raheel","family":"Iftikhar","sequence":"first","affiliation":[{"name":"Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usman","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Shoukat Khanam Memorial Cancer Hospital and Research Center, Lahore, 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