Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival

Abstract

Introduction While most patients with mantle cell lymphoma (MCL) receive therapy shortly after diagnosis, a subset of patients with indolent‐behaving disease can safely defer treatment. In this subgroup, we evaluated the importance of treatment intensity in patients with MCL who defer initial therapy. Methods Out of 1134 patients with MCL from 12 academic centers, we analyzed 219 patients who initiated therapy at least 90 days after diagnosis. Patients who received induction with high‐dose cytarabine and/or autologous stem cell transplantation (ASCT) in first remission were considered to have received intensive therapy (n = 88) while all other approaches were non‐intensive (n = 131). Results There was no difference in progression‐free (PFS; P = .224) or overall survival (OS; P = .167) in deferred patients who received non‐intensive vs. intensive therapy. Additionally, univariate and multivariate Cox proportional hazards models were performed for PFS and OS. Treatment at an academic center (HR 0.43, P = .015) was associated with improved OS in both univariate and multivariate models, while intensity of treatment was not associated with improved OS in either model. Conclusions These results indicate that intensified initial treatment is not associated with improved survival after deferring initial therapy, although prospective studies are needed to determine which of these patients with MCL may benefit from intensive therapy.

Impact of diagnosis to treatment interval in patients with newly diagnosed mantle cell lymphoma

“…The details of the cohort are described elsewhere. 10 , 11 The study was institutional review board approved at all the participating sites and was conducted in accordance with the Declaration of Helsinki.…”

Treatment of Mantle Cell Lymphoma in the Frontline Setting: Are We Ready for a Risk-Adapted Approach?

“…[70]. Similarly, Shanmugasundaram et al showed that those who deferred therapy had a superior 5-year OS of 83.6% versus 72.6% compared to those treated immediately at diagnosis (p = 0.03) [71].…”

“…Subsequent studies have also reported favorable outcomes in patients able to undergo initial observation [ 12 , 70 , 71 , 72 ]. Martin et al showed that delayed treatment (defined as greater than three months) before initiation of first-line therapy was associated with improved OS, compared to those who started treatment immediately.…”

“…[ 70 ]. Similarly, Shanmugasundaram et al showed that those who deferred therapy had a superior 5-year OS of 83.6% versus 72.6% compared to those treated immediately at diagnosis ( p = 0.03) [ 71 ]. Additionally, among patients who were initially observed, once treatment was required, intensive induction strategies failed to produce improved PFS ( p = 0.93).…”