Real-world Data Show Patterns of Care Don’t Follow Recommendations in Mantle Cell Lymphoma

A retrospective analysis of real-world data found a discrepancy between actual care and the recommendations from clinical trials for patients with mantle cell lymphoma, resulting in outcomes that were worse than in trials.

In the real world, outcomes for patients with mantle cell lymphoma (MCL) were worse than in prospective trials, suggesting a need for treatments that can be developed in the community setting, according to a poster presented at the European Hematology Association 2021 Virtual Congress.

The standard first-line treatment in younger patients with MCL is chemoimmunotherapy with or without autologous stem cell transplantation (SCT) consolidation; however, the standard therapy for older patients is bendamustine-rituximab (BR) and rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.

In the poster, the investigators evaluated real-world first-line MCL treatment patterns and outcomes using data captured by Flatiron Health’s nationwide electronic health record–derived deidentified database. The data came from 280 cancer clinics with 800 sites of care.

BR was the most used treatment: 28% of patients younger than 65 years and 49% of patients 65 years and older. In addition, the use of BR increased over time while use of R-CHOP decreased across both age groups. Use of cytarabine-containing regimens remained the same and were used in approximately 30% of patients younger than 65 years.

“There appeared to be some discrepancy between actual patterns of care and recommendations based on clinical trials,” the authors noted.

The median follow-up for patients with documented first-line MCL treatment was 45.5 months, and the median real-world time-to-next treatment (rwTTNT) was 24 months (28 months in patients < 65 years vs 22.3 months in patients ≥ 65 years).

The researchers found 2 predictors of outcomes in the real world:

  • Older age and high-risk disease were associated with worse outcomes
  • Rituximab (R) maintenance—defined as patients who received first-line induction combined with R and R continued as a monotherapy for ≥ 28 days—was associated with superior outcomes

A total of 971 patients were considered SCT eligible, and the authors found no clear rwTTNT or real-world overall survival benefit associated with receiving SCT for this group. The 36-month rwTTNT was 65% for the patients with SCT vs 59% for patients who did not receive SCT. For patients 65 years and older who did not receive SCT, the median rwTTNT was 21.7 months.

“These data highlight the need to develop treatment regimens that can be delivered effectively in routine and community practices, and treatments may not need to be centered around SCT intent in young patients,” the authors concluded.

Reference

Martin P, Wang M, Kumar A, et al. Real-world treatment patterns and outcomes of 4216 previously untreated mantle cell lymphoma patients in US routine clinical practice. Presented at: EHA2021 Virtual; June 9-17, 2021. Poster EP798.