ASH 2023: Overall Survival in Mantle Cell Lymphoma Has Improved in the Era of Targeted Therapies

Mantle cell lymphoma (MCL) has historically been treated using combination chemoimmunotherapy followed by stem cell transplant and has been associated with poor survival outcomes. Within the last decade, a variety of targeted therapies have emerged for the treatment of MCL that have been shown to improve progression-free survival. The benefits of many of these therapies on overall survival (OS), however, has not been described. Investigators therefore sought to compare real-world OS outcomes in MCL across eras of treatment, including before and after the introduction of targeted therapies.

LRF grantee Daniel Ermann, MD of the University of Utah was one of the main contributing investigators in this study. Results were presented by LRF grantee Boyu Hu, MD of the University of Utah.

Using data from the National Cancer Database, the investigators compared survival outcomes for more than 31,800 patients with MCL from 2004 to 2020. Those diagnosed from 2004 to 2013 were considered to be managed in the chemoimmunotherapy era; those diagnosed after 2014 were associated with the introduction of targeted therapies, including Bruton’s tyrosine kinase (BTK) inhibitors. Those diagnosed after 2017 were also associated with the introduction of rituximab maintenance therapy

Among patients diagnosed from 2004 to 2013, the median OS was 5.5 years; median OS was 6.8 years among those diagnosed from 2014 to 2016, and was not reached for those diagnosed after 2017. Median 1-, 3-, and 5-year OS rates increased across these intervals as well, but remained stable in the post-2017 era. After accounting for other factors such as age and comorbidity burden, the risk for death during follow-up decreased for patients diagnosed from 2014 to 2016 by 19% compared with those diagnosed from 2004 to 2013.

The investigators concluded that real-world data demonstrate that survival with MCL has been improved in recent years, which they attribute to the introduction of novel agents such as BTK inhibitors. They noted that additional improvements in OS were not observed following the introduction of rituximab maintenance therapy and suggest this may be related to low rates of stem cell transplant across all time periods evaluated. However, they also noted that more follow-up data are needed to determine the effects of newer therapies, such as CAR T-cell therapies, which were not available during the periods studied.

This study also included contributions from LRF grantees Harsh Shah, DO of the University of Utah; and Deborah Stephens, DO of the University of North Carolina, Chapel Hill.