ASCT Following First Complete Remission Does Not Improve Real-World Survival in Mantle Cell Lymphoma

First-line consolidative autologous stem cell transplant (ASCT) following first complete remission (CR1), with or without maintenance rituximab (Rituxan), did not result in improved overall survival (OS) for patients with mantle cell lymphoma (MCL), according to real-world data from a retrospective chart review presented at the 2023 Transplantation and Cellular Therapy Meetings.

Moreover, findings indicated that patients treated at a safety-net hospital (n = 25) experienced comparable outcomes vs those treated at a tertiary academic institution within the same health-care system (n = 64)—irrespective of whether they received ASCT (n = 33), or they did not (n = 31). The median overall survival (OS) had not yet been reached (NR) in all groups.

In those who received transplant at an academic institution, the 5-year OS rate was 86.3% (95% CI, 73.7%-98.8%); in those who were treated at an academic institution but did not receive transplant, this rate was 64.0% (95% CI, 45.8%-82.3%). For those who were treated at a safety-net hospital, the 5-year OS rate was 79.2% (95% CI, 57.5%-100%) vs 75.4% (95% CI, 64.1%-86.8%) in the overall academic center group.

“Prospective research evaluating the utility of consolidative ASCT in MCL has the potential to personalize treatment paradigms in this unique disease,” lead study author, Heather Reves, MS, BS, of UT Southwestern Comprehensive Cancer Center, Dallas, TX, and colleagues, wrote in a poster of the data.

Other recent, large retrospective studies have not demonstrated improvements in OS outcomes with ASCT for patients with MCL. Additionally, access to options such as ASCT, are limited when patients are treated at safety-net hospitals due to insurance barriers and treatment funding.

This single-institution retrospective chart review analyzed the demographics, treatment patterns, and survival outcomes of patients treated in a safety-net hospital or a tertiary academic institution system to assess the utilization and impact of consolidative ASCT on outcomes for patients with MCL.

The study included 91 patients who were diagnosed with MCL and who received treatment in the UT Southwestern health-care system between 2009 and 2020.

The median age of patients in the academic center group was 65.1 years vs 57.3 years for those in the safety-net hospital group (P = .004). The majority of patients across these 2 groups were male (69% vs 80%; P = .424) and White (92% vs 64%; P < .0001). Six percent and 48% were Hispanic/Latino, respectively (P < .0001).

Twenty-five percent of patients in the academic center group and 20% of those in the safety-net hospital group had blastoid/pleomorphic disease (P = .825). Moreover, 92% of those in both groups had advanced stage (stage III/IV) MCL (P = .683). Six percent and 48% of patients, respectively, had elevated lactate dehydrogenase (P < .0001). In the academic center group, 8% of patients had an ECOG performance status of 2 or higher compared with 11% of those in the safety-net hospital group (P = .717). In the academic center group, 23%, 17%, and 59% of patients had low, intermediate, and high MCL International Prognostic Index (MIPI) scores, respectively; in the safety-net hospital group, those rates were 24%, 24%, and 52%, respectively (P = .688).

Induction therapies received in the academic center and safety-net hospital groups, respectively, included bendamustine (Bendeka) plus rituximab (Rituxan; 30% and 24%), R-CHOP (30% and 4%), NORDIC-1/2/Hyper-CVAD (27% and 44%), and other (13% and 28%). Finally, 81% of eligible patients in CR1 underwent ASCT in the academic center group (n = 29/36) compared with 0% of those in the safety-net hospital group (n = 0/3; P = .013).

Additional data showed that the median real-world time to next treatment (rwTTNT) in patients in the academic center group who underwent ASCT was NR compared with 39.7 months (95% CI, 35.7-43.7) of those in the academic center group who did not receive ASCT. The 5-year rwTTNT rates for these groups were 59.7% (95% CI, 40.9%-78.4%) and 39.4% (95% CI, 20.3%-58.5%), respectively.

In the overall academic center group, the median rwTTNT was 53.7 months (95% CI, 48.2-59.1) compared with 45.4 months (95% CI, 43.5-47.2) for those in the safety-net hospital group. The 5-year rwTTNT rate was 49.7% (95% CI, 37.5%-61.9%) in the overall academic center group and 47.0% (95% CI, 17.8%-100%) in the safety-net hospital group.

Reference

Reves H, Jackson M, Prasad T, et al. Impact of autologous hematopoietic stem cell transplantation (ASCT) in mantle cell lymphoma (MCL): a ‘real-world’ study of treatment patterns and outcomes at a safety-net vs a tertiary academic hospital. Presented at: 2023 Transplantation and Cellular Therapy Meetings; February 15-19, 2023; Orlando, FL; Poster 520.