Clinical trial data presented at the 2019 ASH Annual Meeting suggest that time to relapse can be used to prognosticate outcomes in patients with mantle cell lymphoma (MCL).

In an interview with Oncology Learning Network, lead investigator David Bond, MD, Assistant Professor, Division of Hematology, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, discussed the background and clinical significance of these study results.

What existing data led you and your co-investigators to conduct this research?

Duration of first remission has been established as an important ​prognostic factor in multiple non-Hodgkin lymphoma subtypes, including follicular lymphoma and diffuse large B-cell lymphoma, and in both of these diseases this observation has informed the design of ongoing prospective trials, with high-risk patients with early relapse specifically targeted for investigational approaches to treatment.

Our center previously examined outcomes of patients with early relapse of MCL in data presented at the 2017 ASH Annual Meeting, and saw poor outcomes for patients with early progression of disease; however, given the small sample size and single-center nature of the study, conclusions were limited. 

Visco et al (Br J Haematol. 2019;185[5]:940-944) demonstrated that early time to progression identified patients with poor outcomes after cytarabine-containing induction treatment. Through a collaborative effort including 12 North American tertiary referral centers, my co-investigators and I assessed the prognostic significance of early progression of disease in patients treated with intensive, as well as less intensive, front-line treatment for MCL.

Please briefly describe your study and its findings.

Out of a total of 457 eligible patients with relapsed MCL, we observed a strong correlation between duration of first remission and overall survival among all patients. When separating patients receiving intensive versus less-intensive treatment we saw that duration of first remission correlated with survival in both sub-groups.

We also saw that other established risk factors for outcomes in MCL, including the MIPI risk score, correlated with risk for survival, but when performing multi-variable analysis we determined that relapse within 24 months of starting treatment remained strongly associated with inferior survival—even after accounting for the impact of known prognostic factors. 

Among patients with the shortest duration of remission (<6 months), we saw that of frequently used classes of second-line treatment, Bruton tyrosine kinase inhibitors were associated with a longer progression-free but not overall rate of survival.

What are the possible real-world applications of these findings in clinical practice?

This research adds to our understanding regarding the prognostic significance of duration of remission in MCL, which may help inform physicians when counseling patients, and may be relevant to the design and interpretation of future prospective clinical trials in MCL.

Do you and your co-investigators intend to expand upon this research?

One limitation of our study is the lack of data regarding mutational status of patients and correlation with early progression of disease, and we are interested in exploring the mutation profile of patients with early relapse of MCL in subsequent studies to build upon this current research.