Evolving Frontline Immunochemotherapy for Mantle Cell Lymphoma and the Impact on Survival Outcomes.

Overview

abstract

With the advances in mantle cell lymphoma (MCL) frontline treatment over the last two decades, we sought to characterize the frontline treatment pattern change and its association with outcomes. Patients with newly diagnosed MCL from September 2002 through June 2015 were enrolled in a prospective cohort study, and clinical characteristics, treatment, and clinical outcomes were compared between patients diagnosed in 2002-2009 (Era 1) vs 2010-2015 (Era 2). Patient age, sex and simplified MIPI score were similar between the two groups. In patients with an age ≤65, there were less use of R-Hyper-CVAD (16.1% vs 8.8%) but more Nordic and R-CHOP/R-DHAP regimens (1.1% vs 26.4%), and less use of R-CHOP/R-CHOP-like regimen (64.5% vs 35.2%) but more R-Bendamustine (0% vs 12.1%) in Era 2 (p<0.001). These changes were associated with improved EFS (5-year 34.3% vs 50.0%, p=0.010) and OS (5-year 68.8% vs 81.6%, p=0.017) in Era 2. In patients with an age >65, there were less use of R-CHOP/R-CHOP-like (39.0% vs 14.3%) and non-standard systemic therapy (36.6% vs 13.0%) but more R-Bendamustine (0% vs 49.4%). These changes were associated with a trend for improved EFS (5-year 25.4% vs 37.5%, p=0.051) in Era 2. The shift from R-CHOP/R-CHOP-like regimen to R-Bendamustine was associated with improved EFS (5-year 25.0% vs 44.6%, p=0.008) in Era 2. Results from this prospective cohort study provide critical real-world evidence for improved outcomes with evolving frontline pattern of care in patients with MCL.