Treatment Outcomes and Roles of Transplantation and Maintenance Rituximab in Patients With Previously Untreated Mantle Cell Lymphoma: Results From Large Real-World Cohorts

• Type of Material: Article
• Authors: Peter Martin, New York-Presbyterian Hospital; Jonathon Cohen, Emory University; Michael Wang, The University of Texas MD Anderson Cancer Center; Anita Kumar, Memorial Sloan Kettering Cancer Center; Brian Hill, Cleveland Clinic; Diego Villa, BC Cancer Centre for Lymphoid Cancer and University of British Columbia; Jeffrey Switchenko, Emory University; Brad Kahl, Washington University; Kami Maddocks, Ohio State Univ; Natalie S Grover, University of North Carolina at Chapel Hill; Keqin Qi, Janssen Research and Development; Lori Parisi, Janssen Research and Development; Katherine Daly, Janssen Research and Development; Angeline Zhu, Janssen Research and Development; Gilles Salles, Memorial Sloan Kettering Cancer Center
• Language: English
• Date: 2023-01-20
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by American Society of Clinical Oncology
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1200/JCO.21.02698
• Title of Journal or Parent Work: JOURNAL OF CLINICAL ONCOLOGY
• Volume: 41
• Issue: 3
• Start Page: 541
• End Page: +
• Keywords: Science & Technology; Life Sciences & Biomedicine; INDUCTION THERAPY; 1ST REMISSION; OLDER PATIENTS; OPEN-LABEL; BENDAMUSTINE PLUS RITUXIMAB; MULTICENTER; SURVIVAL; Oncology; TRIAL; INDOLENT
• Research Categories: Biology, Biostatistics; Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

PURPOSECommonly used first-line (1L) treatments for mantle cell lymphoma include high-dose cytarabine-based induction followed by autologous stem-cell transplant (ASCT) for younger patients and several chemoimmunotherapy regimens for older patients. Continuous debates exist on the role of ASCT in younger patients and maintenance rituximab (MR) after bendamustine plus rituximab (BR).METHODSRetrospective data from 4,216 patients with mantle cell lymphoma in the Flatiron Health electronic record-derived deidentified database diagnosed between 2011 and 2021, mostly in US community oncology settings, were evaluated for treatment patterns and outcomes. The efficacy findings with ASCT and MR were validated in an independent cohort of 1,168 patients from 12 academic centers.RESULTSAmong 3,614 patients with documented 1L treatment, BR was the most used. Among 1,265 patients age < 65 years, 30.5% received cytarabine-based induction and 23.5% received ASCT. There was no significant association between ASCT and real-world time to next treatment (hazard ratio [HR], 0.84; 95% CI, 0.68 to 1.03; P =.10) or overall survival (HR, 0.86; 95% CI, 0.63 to 1.18; P =.4) among ASCT-eligible patients. Among MR-eligible patients, MR after BR versus BR alone was associated with a longer real-world time to next treatment (HR, 1.96; 95% CI, 1.61 to 2.38; P <.001) and overall survival (HR, 1.51; 95% CI, 1.19 to 1.92; P <.001). The efficacy findings were consistent in the validation cohort.CONCLUSIONIn this large cohort of patients treated primarily in the US community setting, only one in four young patients received cytarabine or ASCT consolidation, suggesting the need to develop treatments that can be delivered effectively in routine clinical practice. Together with the validation cohort, data support future clinical trials exploring regimens without ASCT consolidation in young patients, whereas MR should be considered for patients after 1L BR and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.