Unmarried or less-educated patients with mantle cell lymphoma are less likely to undergo a transplant, leading to lower survival

Abstract

It is unknown how many mantle cell lymphoma (MCL) patients undergo consolidation with autologous hematopoietic cell transplantation (AHCT), and the reasons governing the decision, are also unknown. The prognostic impact of omitting AHCT is also understudied. We identified all MCL patients diagnosed from 2000 to 2014, aged 18 to 65 years, in the Swedish Lymphoma Register. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression models were used to compare the likelihood of AHCT within 18 months of diagnosis. All-cause mortality was compared between patients treated with/without AHCT using hazard ratios (HRs) and 95% CIs estimated from Cox regression models. Probabilities of being in each of the following states: alive without AHCT, alive with AHCT, dead before AHCT, and dead after AHCT, were estimated over time from an illness-death model. Among 369 patients, 148 (40%) were not treated with AHCT within 18 months. Compared with married patients, never married and divorced patients had lower likelihood of undergoing AHCT, as had patients with lower educational level, and comorbid patients. Receiving AHCT was associated with reduced all-cause mortality (HR = 0.58, 95% CI: 0.40-0.85). Transplantation-related mortality was low (2%). MCL patients not receiving an AHCT had an increased mortality rate, and furthermore, an undue concern about performing an AHCT in certain societal groups was seen. Improvements in supportive functions potentially increasing the likelihood of tolerating an AHCT and introduction of more tolerable treatments for these groups are needed.

Treatment Outcomes and Roles of Transplantation and Maintenance Rituximab in Patients With Previously Untreated Mantle Cell Lymphoma: Results From Large Real-World Cohorts

“… 20 , 21 However, several other studies from the United States, Canada, and Sweden reported much higher rates of ASCT utilization in younger patients (≥ 60%), treated mostly at academic centers. 22 - 24 The different ASCT utilization trends between our study and others suggest that various reasons may affect the decision to undergo ASCT, such as comorbid conditions, limited responses to induction treatments, clinician or patient preference, and access to treatments, including facility type. 21 , 22 , 24 In addition, socioeconomic factors such as marital status, education level, type of insurance, or income may also play a role in treatment choices.…”

Survival in mantle cell lymphoma after frontline treatment with R-bendamustine, R-CHOP and the Nordic MCL2 regimen – a real world study on patients diagnosed in Sweden 2007-2017

“…Moreover, the standardized models in both overall and relative survival models improve reliability of the results. Limitations were the lack of data on molecular markers, comorbidity, second primary malignancies and other factors with potential impact on treatment choice and mortality 15 as well as the low number of patients treated with maintenance rituximab. Furthermore, the delayed entry may potentially have excluded cases with the most treatment-resistant disease.…”

Late effects in patients with mantle cell lymphoma treated with or without autologous stem cell transplantation

“…Importantly, intensive first-line treatment with the Nordic MCL2 protocol including HD-ASCT was not associated with higher rates of the measured late effects compared to less intensive treatment (non-HD-ASCT). In a prior study on the same cohort, selection to treatment with HD-ASCT was also associated with a better OS 28 .…”

“…Consolidation with HD-ASCT was identified primarily in the SLR and additionally in the Swedish Patient Register 26 (using International Classification of Diseases (ICD) codes 27 ) to assure that all transplantations were captured 28 . We used a landmark approach to categorize patients as either HD-ASCT or non-HD-ASCT based on information at 12 months after diagnosis.…”