Analysis Finds Mantle Cell Lymphoma Treatment Varies by Clinical Setting

Autologous stem cell transplantation was underutilized in community settings for mantle cell lymphoma.

Researchers have found considerable variation in the management of mantle cell lymphoma (MCL) across different clinical settings with some unexpected strategies, according to investigators from Weill Cornell Medicine and other health institutions.

Published in the Journal of Clinical Oncology, the analysis found that given the relatively low usage in some settings of autologous stem cell transplantation (ASCT), there may be a role for clinical trials that explore new treatments in the absence of this intensive therapy. The findings also support more routine use of maintenance therapy following standard therapy in patients 65 years of age and older who are not eligible for ASCT.

“We felt it was important to explore real-world differences in treatment patterns and outcomes for lymphoma patients across both settings, given that new treatments are in development,” lead author Peter Martin, MD, said in a press release.

MCL is an aggressive form of B-cell non-Hodgkin lymphoma that is typically diagnosed in middle aged or older adults. Current guidelines for the first-line treatment of patients under 65 years of age recommend an intensive chemotherapy regimen followed by ASCT and maintenance treatment with rituximab.

For patients over 65 years of age who cannot tolerate the intensive chemotherapy required for ASCT, recommended treatments include bendamustine plus rituximab and a variety of other chemotherapy regimens. The guidelines do acknowledge a lack of clinical trial evidence for the use of maintenance rituximab following bendamustine and rituximab to help prevent recurrence. However, its use has become more prevalent in clinical practice, according to the study.

The researchers found 3 significant insights. First, they found that ASCT was underutilized in community settings, with only about 1 in 4 eligible patients receiving the treatment compared with almost half of eligible patients in academic centers.

“This result was surprising given that ASCT has been considered the global standard approach for the past 10 years,” Martin said in the press release. “The much lower utilization in community settings may reflect a lack of access, as it is unavailable in rural areas, or trace to underlying social and demographic factors.”

Second, the investigators found that ASCT was not significantly associated with shorter time to disease progression or improved overall survival (OS) in either treatment setting. Martin noted that stem cell transplantation works well in young patients, but if its use does not improve outcomes and if it continues to be underutilized, future research could investigate new drug regimens that do not require ASCT.

Finally, the study found that among patients who did not undergo ASCT, the use of maintenance rituximab after its combined administration with bendamustine resulted in significantly longer times to disease progression and OS compared with bendamustine alone. For the group receiving maintenance rituximab, 74% of patients did not need another treatment within 3 years compared to 51% of patients who received bendamustine alone.

Furthermore, the 3-year survival rate for the group receiving maintenance rituximab was 84% versus 74% in the bendamustine-only group. Results were similar for patients who received maintenance rituximab after bendamustin and rituximab, in addition to the chemotherapy regimen of rituximab, cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine, and prednisone (known as R-CHOP).

“Our study was observational. We have not drawn causal conclusions about the role of ASCT and look forward to the results from phase 3 clinical trials in progress in Europe and North America for more conclusive direction,” Martin said in the press release. “In the meantime, trials in younger patients should explore less intensive strategies. Similarly, bendamustine-based regimens should likely include the addition of maintenance rituximab.”

REFERENCE

Mantle Cell Lymphoma Treatment Varies According to Setting. News release. Weill Cornell Medicine; June 28, 2022. Accessed July 1, 2022. https://news.weill.cornell.edu/news/2022/06/mantle-cell-lymphoma-treatment-varies-according-to-setting