Mantle cell lymphoma (MCL) recurrence in the central nervous system (CNS) is an uncommon occurrence with a poor prognosis and no approved treatment. For a study, researchers conducted a multicenter retrospective international study on behalf of Fondazione Italiana Linfomi and European Mantle Cell Lymphoma Network to examine the outcomes of patients treated with ibrutinib or chemoimmunotherapy because this covalent Bruton tyrosine kinase (BTK) inhibitor is effective in relapsed/refractory MCL and penetrates the blood-brain barrier (BBB).
In the observational analysis, they enrolled patients with relapsing MCL who were receiving CNS-directed treatment between 2000 and 2019. The comparison of the overall survival (OS) of patients treated with ibrutinib against BBB crossing chemotherapy. To balance treatment cohorts, a propensity score built on a multivariable binary regression model was used. There were 88 patients in total. About 76% of participants were male, with a median age at study entrance of 65 years (range, 39-87), and a median period from lymphoma diagnosis to CNS recurrence of 16 months (range, 1-122). Ibrutinib (n = 29, ibrutinib cohort), BBB crossing chemotherapy (high-dose methotrexate± cytarabine; n = 29, BBB cohort), or other therapies (n = 30, other therapy cohort) were used to treat the patients.
The ibrutinib cohort outperformed the BBB cohort in terms of median OS (16.8 vs. 4.4 months; P =.007) and median progression-free survival (PFS; 13.1 vs. 3.0 months; P =.009). The results of a multivariable Cox regression model showed that the therapeutic choice of ibrutinib was the strongest independent favorable predictive factor for both OS and PFS (hazard ratio [HR], 6.8; 95% CI, 2.2-21.3; P <.001) and PFS (HR, 4.6; 95% CI, 1.7-12.5; P =.002), followed by CNS disease progression (POD) >24 months after the initial MCL diagnosis (HR for death, 2.4; 95% CI, 1.1-5.3; P = .026; HR for death or progression, 2.3; 95% CI, 1.1-4.6; P = .023), the addition of intrathecal (IT) chemotherapy to systemic CNS-directed treatment was not linked with superior OS (P =.502).
Ibrutinib should be considered as a treatment option since it was linked to a better survival rate than BBB-penetrating chemotherapy in individuals with CNS recurrence of MCL.