Treatment Patterns and Outcomes in Older Patients with MCL

Study findings suggest that older patients with mantle cell lymphoma (MCL) may not benefit from maintenance rituximab, due to an inability to tolerate this treatment (BMC Cancer. 2021;21[1]:566. doi:10.1186/s12885-021-08326-1).

“Significant progress has been made in the treatment outcomes of MCL since the introduction of cytarabine and rituximab in modern regimens,” wrote Xinyi Yang, Yong Loo Lin School of Medicine, National University of Singapore, and colleagues, adding “However, older patients may not readily tolerate these agents nor derive benefit.”

Dr Yang and colleagues conducted this retrospective study, aiming to identify the impact of age on treatment patterns and clinical outcomes of patients with MCL in an Asian population.

The study included 66 patients diagnosed with MCL at the National Cancer Centre Singapore between 1998 and 2018. The Kaplan-Meier method and multivariate Cox proportional models were used to conduct survival analyses. The median follow-up duration was 40 months.

Of the 66 patients in this study, 73% were male, and the median age was 59 years (range, 26-84). Most participants (86%) had advanced stage 3-4 disease at diagnosis. When comparing younger and older patients, patients aged 60 years and older were associated more frequently with B-symptoms, (75% vs 38%, P = .0028), anemia (75% vs 35%, P = .0013), and carried higher prognostic risk scores (sMIPI high risk 84% vs 56%, P = .016). Older patients were more commonly administered non-cytarabine-based induction chemotherapy (76% vs 32%, P = .0012).

The 5-year overall survival (OS) was 68%. Progression-free survival (PFS) was 25%. Poor OS was independently associated with older age and anemia, while poor PFS was independently associated with older age and hypoalbuminemia.

Maintenance rituximab following induction chemotherapy improved PFS in younger patients (median PFS of 131 months with maintenance therapy vs 45 months without maintenance therapy), while no survival benefit was associated with older patients.

“We demonstrated in our analysis that older patients with MCL may harbor adverse clinical features and may not derive benefit from maintenance rituximab, highlighting the need for further research in this area of need,” concluded Dr Yang and colleagues.—Marta Rybczynski