In a U.S. “real-world” retrospective cohort study of patients receiving first-line treatment for mantle cell lymphoma reported in the Journal of Clinical Oncology, Peter Martin, MD, and colleagues found that autologous stem cell transplantation (ASCT) did not significantly improve the time to next treatment or overall survival among younger patients; however, they found the addition of maintenance rituximab improved these outcomes among patients receiving first-line bendamustine/rituximab or R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone).
Peter Martin, MD
The study included data from 3,614 patients with documented first-line treatment from the Flatiron Health electronic record–derived de-identified database who were diagnosed between 2011 and 2021. Most patients were from community oncology settings. Outcome measures were real-world time to next treatment and overall survival.
Among 1,265 patients younger than age 65, 30.5% received cytarabine-based induction and 23.5% received ASCT. Among 962 who were transplant-eligible, the median time to next treatment was 59.9 months among 282 who received ASCT vs 48.3 months among 680 who did not receive ASCT (hazard ratio [HR] = 0.84, 95% confidence interval [CI] = 0.68–1.03, P = .10). Median overall survival was 109 months in the ASCT group vs 113 months in the no-ASCT group (HR = 0.86, 95% CI = 0.63–1.18, P = .40).
Among a total of 1,461 patients who were eligible for maintenance rituximab, the median time to next treatment was 65.3 months among 427 patients treated with bendamustine/rituximab who received maintenance rituximab vs 37.7 months among 679 who received bendamustine/rituximab alone (HR = 1.96, 95% CI = 1.61–2.38, P < .001); median overall survival was 89.5 months vs 78.1 months (HR = 1.51, 95% CI = 1.19–1.92, P < .001). Median time to next treatment was 47.8 months among 160 patients receiving R-CHOP with rituximab maintenance vs 18.8 months among 195 receiving R-CHOP alone (HR = 2.17, 95% CI = 1.66–2.83, P < .001); median overall survival was 99.0 months vs 81.9 months (HR = 1.53, 95% CI = 1.06–2.20, P = .023).
The investigators concluded, “In this large cohort of patients treated primarily in the U.S. 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. The data support future clinical trials exploring regimens without ASCT consolidation in young patients, whereas maintenance rituximab should be considered for patients after first-line bendamustine/rituximab and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.”
Dr. Martin, of Weill Cornell Medicine, NewYork-Presbyterian Hospital, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by Janssen Research & Development LLC. For full disclosures of the study authors, visit ascopubs.org.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.