https://orcid.org/0000-0002-2585-1982
Key Points
In transplant-eligible mantle cell lymphoma, the use of RCHOP/RDHAP increases toxicity and healthcare utilization.
For transplant-ineligible patients, the improved overall survivor appears to be from maintenance rituximab.
Abstract
The frontline treatment of patients with mantle cell lymphoma (MCL) varies in practice. We conducted a retrospective population-based study of patients with MCL from 2005 to 2020. We defined transplant eligible (TE) patients as less than 70 who received R-CHOP or R-CHOP/R-DHAP and transplant ineligible (TI) as >70 and treated with BR or other chemoimmunotherapy regimens. The primary outcome was 5-year overall survival (OS), and secondary outcomes included toxicities and healthcare utilization. 426 TE patients were identified: 254 received R-CHOP, and 172 received R-CHOP/R-DHAP. More patients who received R-CHOP/R-DHAP also received an ASCT. 5-year OS of patients treated with R-CHOP/R-DHAP was 70.5% vs 62.0% for patients treated with R-CHOP regardless of transplant status. R-CHOP/R-DHAP had more hospital admissions for fever, infection, neutropenia, and renal toxicity. TI patients received BR (n=303) or historical regimens (n=189). BR was associated with lower mortality. After adjustment, maintenance rituximab was associated with significantly lower mortality (HR 0.33, 95% CI 0.24-0.44). More patients treated with BR had hospital admissions for febrile neutropenia. In this large population-based study, R-CHOP/R-DHAP prior to ASCT showed a trend toward improved 5-year OS. BR did not result in superior OS after adjustment, suggesting other regimens followed by MR may be reasonable.
Author notes
Data sharing: The data from this study is held securely in coded form at ICES. Although legal data-sharing agreements between ICES and data providers prohibit ICES from making the data set publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at https://www.ices.on.ca/DAS.
