Optimal treatment for patients with mantle cell lymphoma (MCL) should account for the presence of concomitant diseases, according to study results published in the British Journal of Haematology.
The researchers evaluated comorbidities and sex differences in causes of death for 1385 patients with MCL (1009 men and 376 women). All patients were diagnosed between 2000 and 2014, and median age was 71 years (range, 22-96). Overall, 44% of patients had a comorbidity, and 28% had severe comorbidities, after median follow‐up of 3.7 years (range, 0-16).
Severe comorbidities were found to be independently associated with higher all‐cause (hazard ratio [HR], 1.52) and lymphoma‐specific mortality (HR, 1.31) compared with patients without comorbidities. Higher all-cause and lymphoma-specific mortality were also seen in patients with connective tissue disease, renal disease, psychiatric disease, and dementia.
The researchers also examined a selection of MCL treatments given to patients with comorbidities. In general, prognosis was most favorable for patients who were selected for the “wait and watch” approach or the Nordic Lymphoma Group (NLG)-MCL 2/3 protocol treatment. In this cohort, few patients younger than 70 years with comorbidities were considered for NGL-MCL 2/3. Most patients with severe comorbidities received chemotherapy, and a higher proportion of women were selected for a “wait and watch” approach compared with men (16% vs 75%).
During the study period, 633 patients (46%) died; the majority (76%) of deaths were due to lymphoma. Nonlymphoma deaths represented a larger proportion of all deaths in women compared with men with any comorbidity. These findings suggest that more efficient lymphoma treatments may need to be considered for patients with severe comorbidities.
“In the development and introduction of new treatment regimens, consideration of tolerability for patients with both somatic and psychiatric comorbidities is important,” wrote the researchers.
1. Glimelius I, Smedby KE, Eloranta S, Jerkeman M, Weibull CE. Comorbidities and sex differences in causes of death among mantle cell lymphoma patients – A nationwide population‐based cohort study [published online November 13, 2019]. Br J Haematol. doi:10.1111/bjh.16317