MCL Has More Hospitalization/Infections Regardless of Transplant/Intensity

Patients with mantle cell lymphoma (MCL) had higher incidence rates of late effects with or without high-dose chemotherapy and autologous stem cell transplant (HD-ASCT) vs matched healthy comparators, according to findings from a study published in Blood Advances.

"We have shown that patients with MCL, irrespective of treatment intensity with or without HD-ASCT, have higher hospitalization rates and particularly higher rates of respiratory disease, blood disorders, and infectious diseases, compared with matched comparators," according to the authors of a study published in Blood Advances.

Investigators reported higher incidence rates of blood diseases and blood-forming organs, infectious diseases, and respiratory diseases in patients with MCL vs healthy matched comparators, with similar rates observed regardless of treatment with or without HD-ASCT. Similar patterns were observed in the sensitivity analyses conducted at 9, 18, and 24 months after diagnosis.

Common respiratory disorders in the MCL population included upper respiratory infections, pneumonia, and influenza. Additionally, bacterial infections constituted the most common infectious disease, with a slightly higher proportion of patients having viral infections after receiving HD-ASCT vs those who did not receive HD-ASCT. Common blood diseases included anemia, idiopathic thrombocyte platelet deficiency, and immunodeficiency.

Investigators noted a 2-fold increase in the rate of outpatient visits during follow-up for patients with MCL compared with general population comparators (incidence rate ratio [IRR], 2.0; 95% CI, 1.8-2.2). Additionally, those with MCL had a higher incidence rate of inpatient visits (IRR, 7.2; 95% 6.3-8.3) and bed days (IRR, 8.3; 95% CI, 6.8-10.1).

Patients receiving HD-ASCT had slightly higher rates of outpatient visits within the first 5 years of diagnosis (IRR, 1.3; 95% CI 1.0-1.6) as well as slightly lower rates of inpatient visits 5 to 10 years after diagnosis (IRR, 0.6; 95% CI, 0.4-0.9) compared with those who did not receive HD-ASCT (IRR, 1.0; IRR, 1.0, respectively). Overall, patients receiving HD-ASCT had a comparable rate of bed days vs those who did not receive HD-ASCT (IRR, 1.1; 95% CI, 0.7-1.6; IRR, 1.0).

“We have shown that patients with MCL, irrespective of treatment intensity with or without HD-ASCT, have higher hospitalization rates and particularly higher rates of respiratory disease, blood disorders, and infectious diseases, compared with matched comparators,” the study author stated. “Avoiding efficient MCL treatment because it is more demanding and possibly cause late effects may seem reasonable in the short term, but our results indicate that most of the long-term healthcare needs in patients aged up to 70 years are related to the lymphoma per se.”

This study included patients 18 to 69 years old who were diagnosed with MCL between 2000 and 2014 based on available data in the Swedish Lymphoma Register. Investigators matched each patient with 10 population comparators based on birth year, sex, and being alive and lymphoma free at the time of diagnosis.

Outcomes included both short- and long-term complications, which investigators defined as health care use or death. Short-term complications for those who underwent HD-ASCT included hospitalization or death due to any cause within 60 day of transplantation. Moreover, long-term complications included first specialist outpatient visit, hospitalization, or death within 15 disease groups, occurring 12 months or later following diagnosis.

The study included 620 patients—of whom 247 received HD-ASCT—and 6200 matched comparators from the general population. The median patient age was 62 years (range, 22-69), and the median follow-up was 5.3 years (range, 1.0-17.7). In the HD-ASCT and non–HD-ASCT groups, respectively, a higher proportion of patients in the former were younger than 60 years (55.1% vs 24.4%), received more than 12 years of schooling (32.4% vs 26.6%), and had a Charlson Comorbidity Index (CC) score of 0 (76.9% vs 57.1%).

Of the patients who received HD-ASCT, 47% had their transplantation within 6 months of diagnosis and 83% had their transplantation within the cutoff period of 12 months.

In terms of clinical characteristics, most patients in the HD-ASCT and non–HD-ASCT groups, respectively, had Ann Arbor stage IV disease (76.8% vs 67.6%). Additionally, 36.7% of those in the HD-ASCT group had low-risk disease vs 28.9% in the non–HD-ASCT group, and 36.2% vs 36.8% had intermediate-risk disease, respectively.

In terms of treatment, 94.4% of patients in the HD-ASCT group received Nordic MCL2 protocol treatment including rituximab (Rituxan) plus dose-intensified cyclophosphamide, vincristine, doxorubicin, prednisone, (R-CHOP) and high-dose cytarabine followed by HD-ASCT compared with 17.5% of those in the non–HD-ASCT group. Additionally, 25.9% of the non–HD-ASCT group received the R-CHOP regimen vs 1.5% of those in the HD-ASCT group.

Frequent short-term complications within 60 days after HD-ASCT included diseases of the blood and blood-forming organs in 27.5% of patients, infectious diseases in 26.3%, circulatory system diseases in 14.2%, and digestive system diseases in 9.3%. Patients were in the hospital for a median of 22 days after HD-ASCT. Additionally, 2 patients died within 60 days of receiving HD-ASCT.

The 5-year cumulative probability of death specific to MCL was 23% (95% CI, 18%-30%) in the HD-ASCT group and 32% (95% CI, 26%-38%) in the non–HD-ASCT group. After eliminating potential differences in age, sex, education level, and CCI between the treatment groups, investigators observed no differences in cumulative probabilities of MCL-specific deaths.

Reference

Ekberg S, Smedby KE, Albertsson-Lindblad A, Jerkeman M, Weibull CE, Glimelius I. Late effects in patients with mantle cell lymphoma treated with or without autologous stem cell transplantation. Blood Adv. 2023;7(5):866-874. doi:10.1182/bloodadvances.2022007241