“New treatments for mantle cell lymphoma (MCL) have improved survival and increased the life expectancy of survivors,” says Ingrid Glimelius, MD, PhD. “However, due to patients with MCL living longer, late effects have become a reality and a problem that needs to be investigated. My colleagues and I wanted to know what side effects to look for, what treatments should be avoided, and how to tailor treatments to individual patients.”

For a study published in Blood Advances, Dr. Glimelius and colleagues examined the extent of late effects among patients with MCL treated with or without high-dose chemotherapy with autologous stem cell transplantation (HD-ASCT). The cohort included adult patients from the Swedish Lymphoma Register (N=620; treated with HD-ASCT, N=247).

Patients With MCL Have Higher Complication Risk

“We gathered data on all diagnostic criteria and treatments and then linked this data to information on patients’ visits with a healthcare professional upon completion of their primary treatment (1 year of follow-up),” Dr. Glimelius says.

Dr. Glimelius and colleagues compared the results to health-, age-, and sex-matched comparators to determine which side effects/late effects to expect from aging and which were higher in patients due to lymphoma and/or treatments. Patients with MCL had higher hospitalization rates, as well as higher risks for hematologic, respiratory, and infectious complications than healthy comparators, after completing the first year of primary treatment.

“Late effects were mainly caused by recurrent lymphoma, so it is of utmost importance to treat the underlying lymphoma,” Dr. Glimelius says. “Unexpectedly, autologous stem cell transplant did not cause a higher disease burden compared with no transplantation. We think this is because patients who did not have a transplant had more relapses, were given more treatment, and thus had more complications. Therefore, the takeaway message was to focus on treating the lymphoma.”

She added that clinicians should not forget to look for secondary complications in survivors of MCL, particularly blood disorders, infections, and secondary cancers.

Focus on Treating the Lymphoma

“Physicians should not reduce treatment for the lymphoma to potentially reduce side effects,” Dr. Glimelius says. “Today, most patients suffer from complications from their underlying MCL and not from the treatment. The majority will also die from their lymphoma and not from a complication due to treatment.”

Dr. Glimelius and colleagues agree that more efficient primary treatments for patients with MCL are needed, both to improve survival and to reduce the risk for relapses and, thus, side effects and late complications. More tolerable treatments are also needed, she adds.

“We would like to see large, randomized trials investigating different treatment concepts in MCL, focusing on late effects,” Dr. Glimelius says. “In our study, we were surprised to discover that there was not more toxicity and late effects in patients who had transplants versus those who did not have transplants. From the perspective of late effects, it does not look as if the transplantation is the source of the problem. Therefore, finding the source requires further investigation.”