In the real-world setting, patients with mantle cell lymphoma (MCL) treated with first-line Bruton’s tyrosine kinase (BTK) inhibitors have a median survival of about 35 months, according to research published in Blood Advances. The analysis also suggested, however, that BTK inhibitor treatment may reduce the negative impact of TP53 mutations.
MCL accounts for up to 10% of all non-Hodgkin lymphomas. Although many treatments recently introduced have improved MCL-related outcomes, the disease’s course is known to be highly heterogenous, with clinical, biological, and patient factors affecting an individual’s prognosis. MCL is, moreover, considered incurable.
In order to determine the effects of novel therapies in the MCL setting, it is essential, according to previous work, that real-world data be analyzed. Although clinical trials are foundational for determining a drug’s likely effects in real-world populations, inclusion criteria can make it difficult to generalize past study samples. For this study, researchers evaluated real-world data to determine treatment patterns and clinical outcomes among patients with MCL.
All data were obtained from Flatiron Health, Inc. Of the 4336 patients noted to have an MCL diagnosis, 4049 were included in the present analysis. In this overall cohort, the median age was 69 years, 71% of patients were male sex, 85% of patients were treated in a community hospital, 5% of patients had a 17p deletion or TP53 mutation, and 7% of patients had blastoid disease.
Analysis showed that the most frequently used first-line therapy was bendamustine plus rituximab (42%); 31% of patients, furthermore, received maintenance rituximab or consolidative autologous stem cell transplant. BTK inhibitors were also frequently used in the second or further therapy lines (57%).
Patients who received BTK inhibitors in the first, second, and third or later therapy lines had a median real-world overall survival of 35 (95% CI, 27-50), 24 (95% CI, 22-30), and 18 months (95% CI, 14-21), respectively.
While short median survival periods were noted among patients with deletion 17p or a TP53 mutation (42 months), as well as those with blastoid disease (26 months), BTK inhibitors mitigated the impact of the former characteristic (hazard ratio, 1.17; 95% CI, 0.88-1.55).
“With longer [overall survival] with BTK inhibitors in the frontline setting (vs subsequent lines) and without the negative influence of del17p/TP53 mutations, our study provides preliminary evidence supporting the use of BTK inhibitors in frail patients who are unable to tolerate intensive frontline chemoimmunotherapy,” the authors wrote in their report.
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Narkhede M, Goyal G, Shea L, Mehta A, Giri S. Evaluating real-world treatment patterns and outcomes of mantle cell lymphoma. Blood Adv. 2022;6(14):4122-4131. doi:10.1182/bloodadvances.2022007247