Study Explores Costs Linked With Adverse Events in Mantle Cell Lymphoma

Hypertension, anemia, and infection were the most common adverse events associated with mantle cell lymphoma (MCL), while hepatotoxicity, stroke, and renal failure were the costliest per patient.

A study examining the economic burden of mantle cell lymphoma (MCL) treatment found that hypertension, anemia, and infection were the most common adverse events (AEs), while the costliest per patient were hepatotoxicity, stroke, and renal failure.

The retrospective study, using data from the Optum Research Database and the Social Security Administration to examine the rare form of non-Hodgkin lymphoma, also found that the most common therapy by far for MCL was the combination of the chemotherapy drug bendamustine and the biologic rituximab (Rituxan).

The authors said the study was undertaken in part because the real-world data available on MCL is limited, with the number of novel agents arriving on the scene affecting researchers’ ability to stay to keep up with developments. There have been 2 other recent studies, but the data was slightly older, or the patients were limited to those younger of age.

“This study shows that AEs are common during treatment and expensive,” the authors wrote in the February issue of Anticancer Research. “Therefore, as new treatments and combinations are being developed and recommended, there must also be focus on management of AEs to achieve the best outcomes for patients.”

AEs and health care costs were significant overall, varying by treatment regimen. Anemia was the only adverse event on the list of most frequent AEs and the costliest. It was the second-most frequent AE, and the fifth costliest, according to the study.

Hypertension (40.5%) was the leading AE in treatment of MCL, followed by anemia (37.7%), infection (36.1%), neutropenia (36.1%), and thrombocytopenia (13.4%).

Due largely to inpatient care, hepatotoxicity ($19,645) had the highest cost per patient per month (PPPM) along with stroke ($18,893), according to the study. The PPPM for renal failure was $9037, followed by atrial fibrillation ($5751), and anemia ($5097). Inpatient costs for nonhematologic AEs were higher than previous studies indicated.

The study used data from 395 patients (69% male) with a median age of 72; 68.65% were enrolled in Medicare Advantage plans. The data was for patients with multiple claims for MCL whose initial claim was submitted from July 2012 through May 2017.

Chemoimmunotherapy remained the most common treatment regimen throughout the dates covered by the study. Ibrutinib (Imbruvica) was the most common for patients in their second or third line of therapy.

On average, patients started therapy 72 days after diagnosis. Nearly all (95%) underwent systemic therapy within the first year.

The most common regimens administered at initiation of the patient follow-up period (at least 1 month after the initial claim) were bendamustine Hcl/rituximab (52%); cyclophosphamide, doxorubicin, vincristine, and rituximab with or without prednisone (designated as R-CHOP; 13%), and ibrutinib (3%).

The majority received rituximab (92%) during the study period either alone or in combination with other drugs. The next most common agents, used either alone or in combination, were bendamustine (62%), cyclophosphamide (26%), vincristine (26%), doxorubicin (22%), ibrutinib (17%), and bortezomib (Velcade; 11%).

The study was funded by AstraZeneca and written in cooperation with Optum.


Kabadi SM, DaCosta Byfield S, Le L, et al. Adverse events and economic burden among patients receiving systemic treatment for mantle cell lymphoma: a real-world retrospective cohort study. Anticancer Res. 2021;41(2):927-936. doi:10.21873/anticanres.14846