Autologous stem cell transplant (ASCT) as first-line treatment for mantle cell lymphoma (MCL) appears to be underutilized in the US community setting, with only approximately 25% of transplant-eligible patients undergoing ASCT, according to the results of a study published in the Journal of Clinical Oncology.
Additionally, no significant association between the receipt of ASCT and overall survival was observed in transplant-eligible patients, and maintenance rituximab after bendamustine plus rituximab (BR) was associated with longer survival compared with BR alone in maintenance-eligible patients.
Using data from 2 large, independent, real-world cohorts, researchers retrospectively evaluated treatment patterns and outcomes in patients with MCL. The researchers assessed the impact of ASCT and maintenance rituximab after BR or rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
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A total of 3614 patients had documented first-line treatment. BR was the most commonly used regimen (41.5%). Among patients younger than 65 years (n=1265), 30.5% received cytarabine-based induction, and 23.5% received ASCT.
The researchers found no significant association between ASCT and time to next treatment (hazard ratio [HR], 0.84; 95% CI, 0.68-1.03; P =.10) or overall survival (HR, 0.86; 95% CI, 0.63-1.18; P =.4) among patients who were considered eligible for ASCT.
However, maintenance rituximab after BR was associated with a longer time to next treatment (HR, 1.96; 95% CI, 1.61-2.38; P =.001) and overall survival (HR, 1.51; 95% CI, 1.19-1.92; P =.001) when compared with BR alone. The researchers confirmed the efficacy findings in a validation cohort (n=1168).
“In this large cohort of patients treated primarily in the US community setting, only one in four young patients received cytarabine or ASCT consolidation, suggesting the need to develop treatments that can be delivered effectively in routine clinical practice,” the researchers wrote. “Together with the validation cohort, data support future clinical trials exploring regimens without ASCT consolidation in young patients, whereas [maintenance rituximab] should be considered for patients after [first-line] BR and [R-CHOP].”
Limitations of the study included the retrospective design, missing data on baseline characteristics, lack of tumor response data, use of real-world time to next treatment as a proxy to define patient eligibility for ASCT or maintenance rituximab, non-randomized use of maintenance rituximab or ASCT, lack of documentation of physician intention regarding treatment choices, and residual biases (selection and immortal time bias).
Disclosures: This research was supported by Janssen Research & Development LLC. Please see the original reference for a full list of disclosures.
Reference
Martin P, Cohen JB, Wang M, et al. Treatment outcomes and roles of transplantation and maintenance rituximab in patients with previously untreated mantle cell lymphoma: results from large real-world cohorts. J Clin Oncol. Published online June 28, 2022. doi:10.1200/JCO.21.02698
This article originally appeared on Hematology Advisor
