In patients with mantle cell lymphoma (MCL), survival and response duration decrease with successive lines of treatment, according to a study published in Blood Cancer Journal.
MCL is currently thought to be incurable, and patients often require multiple lines of treatment. However, there are few studies evaluating patterns of survival and response in patients with MCL who have experienced multiple relapses. As a result, researchers at the Memorial Sloan Kettering Cancer Center retrospectively reviewed the charts of 404 patients with MCL who were followed longitudinally from diagnosis through final treatment.
In total, 386 patients received first-line treatment, 204 received second-line treatment, 115 received third-line treatment, 72 received fourth-line treatment, and 88 received 5 to 9 lines of treatment.
Median overall survival (OS) was 116.3 months following 1 line of treatment, 41.1 months following 2 lines, 25.2 months following 3 lines, 14.4 months following 4 lines, and 8.6 months following 5 or more lines. Median PFS was 47.4 months following 1 line of treatment, 14.0 months following 2 lines, 6.5 months following 3 lines, 5.0 months following 4 lines, and 3.2 months following 5 or more lines.
Treatment including upfront stem cell transplantation (SCT) was associated with improved OS (median, 158.5 vs 71.1 months; P <.01) and PFS (median, 88.7 vs 25.9 months; P <.01) compared with non-SCT-based treatment. Therapy including ibrutinib was associated with increased survival when given as second-line treatment compared with later lines of treatment (OS: hazard ratio [HR], 0.27; P <.01; PFS: HR, 0.52; P =.03).
Being older than 65 years was associated with poorer OS and PFS (P <.01 for both). Patients younger than 65 years when initiating second-line treatment experienced longer OS (median, 93.6 vs 34.0 months) and PFS (16.3 vs 12.3 months).
Patients who experienced early treatment failure, defined as failure to achieve complete response or relapse within 12 months of receiving frontline treatment, had inferior outcomes compared with patients who experienced late treatment failure.
The researchers concluded that “it is important to benchmark treatment outcome by line of therapy and describe the natural history of the disease over time and after multiple recurrences” and noted their results could be useful in establishing appropriate endpoints in future clinical trials assessing novel treatment approaches.
Kumar A, Sha F, Toure A, et al. Patterns of survival in patients with recurrent mantle cell lymphoma in the modern era: progressive shortening in response duration and survival after each relapse [published online May 20, 2019]. Blood Cancer J. doi:10.1038/s41408-019-0209-5