Investigators Survey Long-Term Effects of MCL Treatment in Swedish Patients

A recent study examined the long-term effects of treatment with and without high-dose chemotherapy plus autologous stem cell transplantation (HD-ASCT) in Swedish patients with mantle cell lymphoma (MCL), indicating worse outcomes overall, regardless of treatment type, when compared with healthy matched comparators.

After 12 months of follow-up, patients with MCL experienced higher rates of hospitalization (incidence rate ratio [IRR] 7.2; 95% CI, 6.3-8.3), underwent twice as many specialist visits (IRR 2.0; 95% CI, 1.8-2.2), and had 8 times as many bed days (IRR 8.3; 95% CI, 6.8-10.1) vs the general population. Investigators also observed especially high risks of infectious, respiratory, and blood disorders in patients with MCL relative to the matched comparison group. The most common cause of death for patients with MCL was the disease itself rather than a related cause or complication.

“Taken together, our results imply that the vast majority of the post-treatment health care needs are related to the lymphoma disease itself, thus indicating the need for more efficient treatment options,” investigators wrote.

Notably, there was no difference in the rate of complications, including in secondary neoplasms, between HD-ASCT and non–HD-ASCT treated patients. Those treated with HD-ASCT had a slightly higher rate of outpatient visits vs those treated without HD-ASCT for the first 5 years after diagnosis and lower rates of inpatient visits after 5 years. There was no difference between treatment arms in the rate of bed days.

Patients with MCL were also substantially more prone to diseases of the blood and blood-forming organs, infectious diseases, and diseases of the respiratory system vs the general population, regardless of treatment type. The predominant hematologic diseases and disorders were anemia, idiopathic thrombocyte platelet deficiency, and immunodeficiency. The most frequent neoplasms aside from MCL were melanoma, prostate cancer, and neoplasms of the skin and urinary tract.

Moreover, death from causes other than MCL were rare in both treatment cohorts. The cumulative 5-year probability of MCL-specific death was 23% (95% CI, 18%-30%) in HD-ASCT treated patients and 32% (95% CI, 26%-38%) in non–HD-ASCT treated patients. Any differences in the probability of MCL-specific death between treatment cohorts were eliminated after controlling for differences in age, sex, Charlson comorbidity index (CCI), and education level.

The study evaluated 620 patients with MCL vs 6200 matched comparators from the general population, 247 (40%) of whom were treated with HD-ASCT within 12 months of diagnosis. The HD-ASCT induction regimen generally consisted of rituximab (Rituxan) plus cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (maxi-CHOP) alternating with rituximab plus cytarabine according to the Nordic MCL2 protocol. Additionally, patients underwent consolidative high-dose chemotherapy with carmustine (BCNU), etoposide, cytarabine and melphalan (BEAM) or carmustine, etoposide, cytarabine and cyclophosphamide (BEAC) before transplantation. Non-ASCT treated patients were mostly treated with rituximab plus CHOP with or without cytarabine or rituximab plus bendamustine. Some patients were treated with chlorambucil alone prior to 2010.

At matching, the median age of the patient group was 62 years (range, 22-69). The study had a median follow-up of 5.3 years (range, 1-17.7). Patients treated with HD-ASCT were generally younger, more educated, and had lower comorbidity burdens vs non­–HD-ASCT patients.

“Avoiding efficient MCL treatment because it is more demanding and possibly causes late effects may seem reasonable in the short term, but our results indicate that the vast majority of long-term health care needs in patients up to 70 years is related to the lymphoma per se,” investigators concluded.

Overall, the study highlighted the urgent need for improved treatment efficacy in MCL.

Reference

Ekberg S, Ekström Smedby K, Albertsson-Lindblad A, Jerkeman M, Weibull CE, Glimelius I. Late effects in mantle cell lymphoma patients treated with or without autologous stem cell transplantation. Blood Adv. Published online August 16, 2022. doi:10.1182/bloodadvances.2022007241