A study presented at the European Hematology Association (EHA) Annual Meeting (June 11-21, 2020) shed light on real-world outcomes in patients with mantle cell lymphoma (MCL) who were treated with rituximab plus bendamustine (R-bendamustine); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP); rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone, and etoposide (R-CHOEP); or the Nordic Mantle Cell Lymphoma-2 (MCL-2) treatment protocol.
Optimal treatment of patients with MCL with respect to long-term survival is not well defined. Clinical trials often focus on how to integrate novel agents in immunochemotherapy regimens, but long-term evaluations of currently recommended treatment strategies in unselected cohorts are limited.
Alexandra Albertsson Lindblad, MD, Lund University (Sweden), and colleagues designed a study to evaluate overall and relative survival associated with primary treatment regimens in a population-based cohort (n = 592). The study was specifically focused on currently recommended regimen, including MCL-2 (n = 268), R-bendamustine (n = 231), or R-CHOP/R-CHOEP (n = 93).
Researchers noted that patients who received R-bendamustine and R-CHOP/R-CHOEP were comparable with regard to median age, performance status, and distribution of MIPI risk groups. Patients who received MCL-2 tended to be younger, had better performance status at diagnosis, and were less frequently classified with high-risk MIPI compared with patients treated with R-CHOP/R-CHOEP and R-bendamustine.
Dr Lindblad and colleagues reported a superior overall and relative survival among patients treated with MCL-2 compared with patients treated with R-bendamustine or R-CHOP/R-CHOEP. However, no difference was observed between patients treated with MCL-2 and those treated with R-bendamustine after adjusting for age at diagnosis, sex, and diagnosis year.
Furthermore, researchers added that the adjusted results showed inferior survival for patients who received R-CHOP/R-CHOEP compared with those who received MCL-2 and R-bendamustine regimens.
“This population-based study on long-term survival in an unselected national cohort of MCL patients supports the use of R-bendamustine or intensified immunochemotherapy with HD-AHCT upfront (such as MCL-2) over R-CHOP/R-CHOEP,” authors of the study concluded. “Future real-world analyses incorporating data on comorbidity, molecular characteristics of the disease, and treatment strategies at relapse is needed…for a deeper understanding of prognosis in MCL and to improve outcomes in these patients.”—Zachary Bessette
