The following is a summary of “Treatment Outcomes and Roles of Transplantation and Maintenance Rituximab in Patients With Previously Untreated Mantle Cell Lymphoma: Results From Large Real-World Cohorts,” published in the January 2023 issue of Oncology by Martin, et al.
For younger patients, high-dose cytarabine-based induction followed by autologous stem-cell transplant (ASCT) was a common first-line (1L) treatment for mantle cell lymphoma, whereas numerous chemoimmunotherapy regimens were employed for older individuals. The usefulness of ASCT in younger patients and maintenance rituximab (MR) following bendamustine plus rituximab (BR) were topics of ongoing controversy.
Retrospective data from 4,216 individuals with mantle cell lymphoma were assessed for treatment patterns, resulting in the Flatiron Health electronic record-derived deidentified database between 2011 and 2021. The majority of the patients were treated in US community oncology settings. In addition, an independent cohort of 1,168 patients from 12 academic institutes verified the effectiveness findings with ASCT and MR.
BR was most often utilized among 3,614 patients who had recorded 1L therapy. 1,265 individuals <65 years underwent ASCT in 23.5% of cases and cytarabine-based induction in 30.5%. Among patients who were eligible for ASCT, there was no correlation between ASCT and real-world time to subsequent therapy (hazard ratio [HR], 0.84; 95% CI, 0.68 to 1.03; P = .10) or overall survival (HR, 0.86; 95% CI, 0.63 to 1.18; P = .4). Real-world time to subsequent therapy and overall survival (HR, 1.51; 95% CI, 1.19 to 1.92; P < .001) were also longer among MR-eligible patients who received MR after BR compared to BR alone (HR, 1.96; 95% CI, 1.61 to 2.38; P< .001) and respectively. The validation cohort’s effectiveness results were consistent.
Only one in four young patients in the large cohort treated in the US community setting got cytarabine or ASCT consolidation. This indicates the need for therapies that may be successfully administered in everyday clinical practice. Findings from the validation cohort supported future clinical trials looking at regimens without ASCT consolidation in young patients, but individuals who have had 1L BR and rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone should be given MR consideration.