Findings from a real-world study show bendamustine plus rituximab was the most commonly used first-line treatment for mantle cell lymphoma (MCL) in the United States and that receipt of stem cell transplant was not common.

These findings were presented by Peter Martin, MD, Weill Cornell Medicine, New York-Presbyterian Hospital, NY, lead author of the study, at the virtual 2021 ASCO Annual Meeting.

The aim of this study was to assess real-world treatment patterns and identify factors associated with outcomes among patients with MCL in the United States.

Using the nationwide Flatiron Health EHR-derived deidentified database, Dr Martin and colleagues analyzed patient characteristics, treatments patterns, time to next treatment (TTNT), and real-world overall survival (OS) in patients who were diagnosed with MCL between January 2011 and November 2020.

A total of 3455 patients were identified, 85.3% of whom were from a community oncology setting and were documented as having received first-line MCL treatment.

The median age of patients from the community oncology setting was 69.5 years, and 9.5% of those patients had blastoid/pleomorphic MCL. Of patients with available MCL international prognostic index, 39.6% had intermediate risk, while 35.6% had had high risk. In patients with available Eastern Cooperative Oncology Group (ECOG) performance status (PS), 12% had PS of 2 or higher. The most common first-line treatment in this study was chemoimmunotherapy. Of the 1036 patients participating in this study who were less than 65 years, 243 patients received first-line stem cell transplant. 

The median real-world TTNT was 24 months in patients who received first-line therapy with median follow-up of survivors of 45.3 months, while the 36-month real-world OS was 67%.

Age 65 years and older, ECOG PS of 2 or higher, LDH/ULN of 1 or higher, WBC of 10 or higher by 109/L, bulky disease, and blastoid/pleomorphic morphology were all factors associated with shorter real-world TTNT and real-world OS, while receipt of rituximab maintenance was associated with longer real-world TTNT and real-world OS.

Real-world TTNT and real-world OS (36-month) in patients older than 65 years who were alive and did not initiate subsequent treatment within 6 months of first-line treatment were similar, regardless of whether they were treated with stem cell transplant. The median first-line real-world TTNT for patients with MCL was 2 years.

“As with other reports, older age and high-risk disease features were predictive of worse outcome in RW [real-world], while MR [maintenance rituximab] appeared to be associated with better outcomes,” concluded Dr Martin and colleagues, adding “Outcomes across the board appear worse than prospective trials, suggesting a need to focus on developing tx [treatment] that can be delivered effectively in the community setting.”—Marta Rybczynski

Martin P, Wang M, Kumar A, et al. Real-world (RW) treatment (tx) patterns and outcomes of 3,455 previously untreated mantle cell lymphoma (MCL) patients (pts) in U.S. routine clinical practice. Presented at: the 2021 ASCO Annual Meeting; June 4-8, 2021; virtual. Abstract 7504.