Outcome of COVID-19 in Patients With Mantle Cell Lymphoma—Report From the European MCL Registry

Tilch, Marie-Kristin; Visco, Carlo; Kinda, Sandra Bašić; Hermine, Olivier; Kohn, Milena; Besson, Caroline; Lamure, Sylvain; Duléry, Rémy; S, Ragaini; Eyre, Toby A.; Meerten, Tom van; Ohler, Anke; Eckerle, Steffen; Dreyling, Martin; Heß, Georg; Giné, Eva; Silva, Maria Gomes da

doi:10.1097/hs9.0000000000000711

Cited by 10 publications

(9 citation statements)

References 36 publications

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“…45,46 Patients with MCL in particular appear to be at high risk for mortality with COVID-19. 47 Hopefully, with the ever-improving array of COVID-19 therapeutics, as well as prophylactic monoclonal antibody therapies, this will gradually become less of an issue, but we still unfortunately need to factor this into our decision making.…”

Section: Suggested Approaches To Managementmentioning

confidence: 99%

Frontline Therapy in Mantle Cell Lymphoma: When Clinical Trial and Real-World Data Collide

Fenske

2023

JCO

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The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology , to patients seen in their own clinical practice. A large number of frontline treatment options exist for mantle cell lymphoma (MCL), making selection of therapy a challenge for the clinician. In this Oncology Grand Rounds article, the case of a 73-year-old woman with MCL who attained remission with bendamustine and rituximab is presented. The relevant literature regarding frontline therapy is then reviewed, with particular focus on selection of induction regimen and the potential roles for autologous transplantation and/or rituximab maintenance. This literature primarily consists of prospective phase 2 and phase 3 clinical trials; however, added to this literature now is a growing body of large retrospective real-world cohorts, such as the new analysis by Martin et al, 35 the manuscript that accompanies this Oncology Grand Rounds article. In some cases, the real-world evidence is at odds with data from prospective clinical trials, such as regarding the role of rituximab maintenance after bendamustine plus rituximab induction. These important new real-world data are put into context of an ever-changing treatment landscape, in hopes of aiding clinicians in frontline treatment selection for patients with MCL.

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Section: Suggested Approaches To Managementmentioning

confidence: 99%

Frontline Therapy in Mantle Cell Lymphoma: When Clinical Trial and Real-World Data Collide

Fenske

2023

JCO

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“… 15 , 16 All patients in the aforementioned first-line phase 2 trials received rituximab in combination with ibrutinib, whereas the use of rituximab in this study varied between centers and was surprisingly low at 39% overall. Low usage likely reflects clinician concern during the pandemic based on reports associating rituximab with more severe COVID-19 outcomes 17 , 18 and reduced vaccine efficacy. 19 In this study, we observed a trend toward improved ORR and CR rates in patients receiving rituximab, in keeping with evidence to date; however, findings were limited by the small sample size and a bias toward the use of rituximab in more favorable prognostic groups, including those with a good performance status (ECOG status, 0-1) and low risk disease.…”

Section: Discussionmentioning

confidence: 99%

Ibrutinib as first-line therapy for mantle cell lymphoma: a multicenter, real-world UK study

Tivey,

Shotton,

Eyre

et al. 2024

Blood Advances

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During the Covid-19 pandemic, ibrutinib +/- rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. As limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib +/- rituximab for untreated MCL were evaluated for treatment toxicity, response and survival, including outcomes in high-risk MCL (TP53 mutation/deletion/p53 overexpression, blastoid/pleomorphic, or Ki67 >/=30%). 149 patients from 43 participating centres were enrolled: 74.1% male, median age 75, 75.2% ECOG 0-1, 36.2% high-risk, 8.9% autologous transplant candidates. All patients received >/= 1 cycle ibrutinib (median 8 cycles), 39.0% with rituximab. Grade >/= 3 toxicity occurred in 20.3%, 33.8% required dose reductions/delays. At 15.6 months (mo) median follow-up, 41.6% discontinued ibrutinib; 8.1% due to toxicity. Of 104 response-assessed patients, overall (ORR) and complete response (CR) rates were 71.2% and 20.2% respectively. ORR was 77.3% (low-risk) vs. 59.0% (high-risk), p=0.05, and 78.7% (ibrutinib-rituximab) vs. 64.9% (ibrutinib), p=0.13. Median progression-free survival was 26.0mo (all patients); 13.7mo (high-risk) vs. not reached (NR) (low-risk), p=0.004. Median overall survival was NR (all); 14.8mo (high-risk) vs. NR (low-risk), p=0.005. Median post-ibrutinib survival was 1.4mo, longer in 41.9% patients receiving subsequent treatment (median 8.6 vs 0.6mo, p=0.002). Ibrutinib +/- rituximab was effective and well tolerated as first-line treatment of MCL, including older and transplant-ineligible patients. PFS and OS were significantly inferior in one-third of patients with high-risk disease and those unsuitable for post-ibrutinib treatment, highlighting the need for novel approaches in these groups.

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“…The clinical outcome of COVID‐19 in patients with solid cancers and HMs has been explored in a series of studies in the early phase of the SARS‐CoV‐2 pandemic period, indicating that those with malignancies were at increased risk of severe COVID‐19 outcomes 19 . COVID‐19 disproportionately impacted lymphoma patients, with a relatively high mortality rate (13%–44%) 9,16,20,21 . The subsequent Omicron variants of SARS‐CoV‐2, which harbor multiple novel spike protein mutations, were found to have increased infectivity compared with the delta variants but decreased hospitalization rate and mortality 22 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of COVID‐19 in patients with lymphomas participating in registered clinical trials: A real‐world study from China in the Omicron outbreak era

Sun,

Yang,

Zhao

et al. 2023

Cancer Medicine

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BackgroundThis real‐world study investigated the outcome of COVID‐19 in lymphoma patients participating in registered clinical trials and explored potential risk factors with the outcome of COVID‐19 during the first wave of the Omicron outbreak in China.MethodsOne hundred and ten patients participating in registered clinical trials and diagnosed with COVID‐19 in our center between December 1, 2022, and January 31, 2023, were included.ResultsFour (3.6%) patients were identified as severe COVID‐19 and 2 (1.8%) as critical COVID‐19, respectively. The mortality rate observed was 2.73% for the entire cohort, 33.3% for the severe/critical COVID‐19 group, and 18.8% for the hospitalized group. The 90‐day OS was 98.2% for the entire cohort, 66.7% for the severe/critical COVID‐19 group, and 87.5% for the hospitalized group. Advanced age (≥70 years), comorbidities, and PI3K inhibitor‐containing regimen were significantly associated with the severity of COVID‐19. Patients with indolent B‐cell non‐Hodgkin lymphomas were less likely to be hospitalized for COVID‐19.ConclusionThis study reported similar clinical features of COVID‐19 in our cohort with that of non‐hematological malignancy (HM) patients, while the proportion of severe/critical COVID‐19 and the mortality rate were relatively higher than non‐HM patients. Our findings provided valuable experience to aid clinical researchers with managing lymphoma patients participating in registered clinical trials during the ongoing pandemic of the Omicron variant.

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Outcome of COVID-19 in Patients With Mantle Cell Lymphoma—Report From the European MCL Registry

Cited by 10 publications

References 36 publications

Frontline Therapy in Mantle Cell Lymphoma: When Clinical Trial and Real-World Data Collide

Frontline Therapy in Mantle Cell Lymphoma: When Clinical Trial and Real-World Data Collide

Ibrutinib as first-line therapy for mantle cell lymphoma: a multicenter, real-world UK study

Outcomes of COVID‐19 in patients with lymphomas participating in registered clinical trials: A real‐world study from China in the Omicron outbreak era

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