Blood cancers

‘Unsatisfactory’ outcomes for older patients with Mantle cell lymphoma

Older patients with mantle cell lymphoma who are unfit for standard immunochemotherapy have generally poor outcomes when treated with low-intensity regimens instead, a new study shows.

An “attenuated” regimen of low-intensity immunochemotherapy is often offered in older, unfit MCL patients, but outcomes with such an approach have been relatively unexplored, says researchers from the UK.

Their new analysis included 95 patients treated with low-intensity therapy across 19 centres; all patients were considered unfit for full-dose rituximab-bendamustine or rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP).

Patients received various regimens, including rituximab-cyclophosphamide, vincristine, and prednisolone (R-CVP; 19 patients), dose-attenuated R-CHOP (22 patients), dose-attenuated rituximab-bendamustine (24 patients), or rituximab-chlorambucil (30 patients). Results of the analysis were published in the British Journal of Haematology.

“Across the whole cohort, older MCL patients with comorbidities do not do well with reduced dose chemotherapy plus an anti-CD20 [agent],” Dr Toby Eyre, of Oxford University Hospitals NHS Foundation Trust and the study’s senior author, told the limbic.

The median age in the study was 79 years, and half the cohort were over the age of 80. The median Cumulative Illness Rating Scale-Geriatric was 6, on a scale from 0 to 24.

The median progression-free survival in the cohort was 15 months, and the median overall survival was 31.4 months. On a multivariable analysis, the only clinical factor associated with inferior PFS was blastoid morphology, with a hazard ratio for progression of 2.90 (p = .01).

“Of the subgroups, the ‘best’ outcomes were in those where higher intensity regimens” – such as R-CHOP or rituximab-bendamustine – “were used at reduced dose,” Dr Eyre said.

Those regimens offered independently superior PFS compared with R-CVP or rituximab-chlorambucil (p = .02).

Several factors were associated with inferior overall survival, including Eastern Cooperative Oncology Group Performance Status (p = .04), blastoid morphology (p = .001), and progression of disease at <24 months status (p < .001).

The OS in this group was “unsatisfactory,” the authors wrote, and Dr Eyre told the limbic that it represented an area where further study was warranted.

“This patient population is understudied in clinical trials, and may be the group where novel non-chemotherapeutics, for example BTK inhibitors [or] BCL2 inhibitors, may be most useful,” he said.

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