The Dramatic Impact of the War on Access to Treatment for Lymphoma Patients. a Report from the Ukrainian Lymphoma Registry

INTRODUCTION The Ukrainian Lymphoma Registry (ULR) was established in 2019 with the aim of monitoring the quality of diagnosis, staging and treatment of malignant lymphoma (ML) in Ukraine through a prospective enrollment of patients with a newly diagnosed ML. The ULR was launched by the Ukrainian National Cancer Institute (NCI) and accounts for seven contributing Institutions at the start of hostilities in February 2022. On 24 February 2022, a full-scale armed conflict broke out in Ukraine, including Kyiv, leading to the displacement of the population to safer regions. As a consequence, many lymphoma patients lost the opportunity to be referred to specialized hematologic Centers, and to be treated according to the most appropriated up-to-date strategies. Here we present the impact of the war in Ukraine on access of lymphoma patients in specialized Centers, through the comparison of the registration rates of patients between February 24 and July 15, 2022 and those registered during peacetime.

METHODS The ULR prospectively collect information on baseline clinical and pathologic characteristics, first-line treatment, and response assessment of all new cases of ML classified according to the WHO 2016 classification. Registration is performed online on a secured dedicated database. Electronic Case Report Forms are reviewed and verified by the ULR team.

RESULTS So far, 639 patients with newly diagnosed ML were registered by the ULR between October 2019 and July 2022. Until February 2022 before the outbreak of hostilities, a total of 611 patients were registered, with an average of 22 per month (range 12 to 31). In the period February 24 - July 15, 2021, sixty three new cases were registered, whereas only 28 (-56%) have been registered in the same time frame of the current 2022 year, although the 7 Institutions contributing to the ULR continued their efforts to maintain diagnostic and therapeutic activities. More in details: only two new patients admitted between February 24 and April 30; 9 patients, between May 1 to 31: 11 patients, between June 1 to 30; and 6 patients between July 1 to 15. By age distribution, 10,7% of patients were under 30 years old, 50% between 30 - 49, 28,6% in 50- 64, while 10,7% were over 65 years. The median age was 44,1 years (range 21-73), 39,3% were female. Overall, 71,4% (20 patients) represent B-cell malignancies, 25% (7 patients) - HL and 3,6% (1 patient) were affected by PTCL.

CONCLUSION Since the start of the war, a dramatic 56% decrease in the number of newly diagnosed lymphoma patients was admitted to the seven institutions participating to the ULR. Most likely this situation will undoubtedly have a relevant impact on the access to appropriate treatments and ultimately will translate in a reduced chance of cure and long term survival. When the analysts calculate the costs of the war we should also take in account the number of lives lost not on the battle fields but for denied access to treatments.

The research was funded by: Associazione Angela Serra for Cancer Research, Italy

No relevant conflicts of interest to declare.