Real-World Treatment Patterns and Outcomes in Newly Diagnosed MCL

Findings from a retrospective study show 1 in 4 young patients with mantle cell lymphoma (MCL) received first-line cytarabine followed by autologous hematopoietic stem cell transplant (autoHSCT) in the real-world setting, suggesting a need for novel treatments in routine clinical practice.

“Commonly used first-line treatments for [MCL] include high-dose cytarabine-based induction followed by [autoHSCT] for younger patients and several chemoimmunotherapy regimens for older patients,” wrote Peter Martin, MD, Weill Cornell Medicine, New York, NY, and colleagues, adding “Continuous debates exist on the role of [autoHSCT] in younger patients and maintenance rituximab after bendamustine plus rituximab.”

This study retrospectively reviewed treatment patterns and outcomes data from 4216 patients with MCL. These data were derived from the Flatiron Health database and included patients diagnosed between 2011 and 2021, mostly in US community oncology setting.

Among 3614 patients with documented first-line treatment, bendamustine plus rituximab was the most commonly used. Among 1265 patients aged <65 years, 30.5% received cytarabine-based induction and 23.5% received autoHSCT. Study authors noted no significant association between autoHSCT and real-world time to next treatment (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.68 to 1.03; P = .10) or overall survival (HR, 0.86; 95% CI, 0.63 to 1.18; P = .4) among autoHSCT-eligible patients.

Among patients eligible for maintenance rituximab, maintenance rituximab after bendamustine-rituximab was associated with a longer real-world time to next treatment (HR, 1.96; 95% CI, 1.61 to 2.38; P < .001) and overall survival (HR, 1.51; 95% CI, 1.19 to 1.92; P < .001) compared to bendamustine-rituximab alone.

“Together with the validation cohort, data support future clinical trials exploring regimens without [autoHSCT] consolidation in young patients,” the study authors concluded, “whereas [maintenance rituximab] should be considered for patients after [first-line bendamustine-rituximab] and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.”

Source:

Martin P, Cohen JB, Wang M, et al. Treatment Outcomes and Roles of Transplantation and Maintenance Rituximab in Patients With Previously Untreated Mantle Cell Lymphoma: Results From Large Real-World Cohorts. J Clinl Oncol. Published online June 28, 2022. doi:10.1200/jco.21.02698