e19074 Background: Angioimmunoblastic T cell lymphoma (AITL) is a distinct and aggressive subtype of peripheral T cell lymphoma characterized by immune dysregulation and frequent presentation with advanced stage disease. Predominantly affects older adults and is associated with inferior survival outcomes compared with many B cell lymphomas, despite advances in clinical practice. Although therapeutic advances and supportive care strategies have improved outcomes across lymphoma subtypes, patients aged ≥75 y remain underrepresented in clinical trials, resulting in limited real world data to guide management in this population. Advanced age is often accompanied by higher comorbidity burden and barriers to specialized care that may influence outcomes independently of disease biology. The impact of treatment facility type on outcomes in elderly patients with AITL is not well defined. Methods: We conducted a retrospective analysis of patients aged ≥75 y diagnosed with AITL in the US between 2004-2022 using the National Cancer Database. Demographic, socioeconomic, clinical, treatment, and survival characteristics were compared between patients treated at Academic Cancer Programs (ACP) and Community Cancer Programs (CCP). Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between the two cohorts. Variables used for adjustment included age, ethnicity, insurance status, distance from hospital, and Charlson-Deyo comorbidity score. Results: A total of 2,117 patients aged ≥75 y with AITL were identified including 1,112 treated at ACP and 1,005 treated at CCP. Median age was 80 y in both cohorts, and most patients presented with advanced stage. The majority were insured through Medicare, and baseline comorbidity burden was substantial and similar across treatment settings. Patients treated at ACP were more likely to receive treatment, while a high proportion of patients treated at CCP (45%) had no treatment given or had unknown treatment status. Time from diagnosis to initiation of chemotherapy was significantly shorter at ACP compared with CCP.OS favored patients treated at ACP, with higher two year (37% vs 30%), five year (24% vs 17%), and ten year (11% vs 5%) survival compared with CCP. Conclusions: In this national cohort of patients aged ≥75 y with AITL,OS differed significantly by treatment facility type, with a statistically significant and clinically meaningful survival advantage observed among patients treated at ACP. These findings underscore persistent disparities in treatment delivery and early mortality in this vulnerable population and support efforts to strengthen referral pathways to ACP or develop structured partnerships between CCP and ACP. Such strategies may facilitate timely access to specialized care, multidisciplinary expertise, and clinical trials for older adults with aggressive T-cell lymphomas.
Reyes-Uribe et al. (2026) studied this question.