Autologous Stem-Cell Transplant Underutilized Among Patients With Mantle Cell Lymphoma in US Community Settings

Study findings reveal that among a large cohort of patients treated primarily in the US community setting, one in four patients received cytarabine or autologous stem-cell transplant (ASCT) consolidation, indicating the need to develop treatments that can be delivered effectively in routine clinical practice (J Clin Oncol. 2022; JCO2102698. doi:10.1200/JCO.21.02698).

Peter Martin, MD, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY and colleagues wrote, “Commonly used first-line (1L) treatments for mantle cell lymphoma include high-dose cytarabine-based induction followed by [ASCT] for younger patients and several chemoimmunotherapy regimens for older patients," adding, "Continuous debates exist on the role of ASCT in younger patients and maintenance rituximab (MR) after bendamustine plus rituximab (BR).”

The researchers assessed retrospective data captured in the nationwide Flatiron Health electronic health record–derived deidentified database for treatment patterns and outcomes from 4216 patients with mantle cell lymphoma who were diagnosed between 2011 and 2021 .

The efficacy findings with ASCT and MR were confirmed in an independent cohort of 1168 patients from 12 academic centers.

Among 3614 patients with documented 1L treatment, BR was the most used. Among 1265 patients age < 65 years, 30.5% received cytarabine-based induction and 23.5% received ASCT. There was no significant correlation between ASCT and real-world time to next treatment (hazard ratio [HR] 0.84; 95% CI, 0.68–1.03; P = .10) or overall survival (HR 0.86; 95% CI, 0.63–1.18; P = .4) among ASCT-eligible patients.

Among MR-eligible patients, MR after BR vs BR alone was associated with a longer real-world time to next treatment (HR 1.96; 95% CI, 1.61–2.38; P < .001) and overall survival (HR 1.51; 95% CI, 1.19–1.92; P < .001). The efficacy findings were consistent in the validation cohort.

“Our analysis showed that ASCT was underutilized in the US community setting. In patients considered ASCT-eligible, there was no significant association between the receipt of ASCT and overall survival. Importantly, among patients considered eligible for maintenance, maintenance rituximab after BR was associated with longer survival vs BR alone,” wrote Dr Martin and colleagues.