Shorter response duration and survival after each treatment relapse in MCL

A retrospective study of 404 consecutive patients with mantle cell lymphoma (MCL) treated between 2000 and 2014 showed that median overall survival (OS) and progression-free survival (PFS) were 9.7 and 4.0 years, respectively after first line treatment.

In total, 386 patients received first-line treatment, 204 received second-line treatment, 115 received third-line treatment, 72 received fourth-line treatment, and 88 received 5 to 9 lines of treatment.

After second-line therapy, median OS and PFS were 41.1 and 14.0 months, respectively. Median OS and PFS after third-line therapy were 25.2 and 6.5 months, respectively, and 14.4 and 5.0 months, respectively, after fourth-line therapy. Early treatment failure, including failure to achieve complete remission or relapse in less than 12 months after first-line regimens, was significantly associated with worse OS (5.9 vs. 2.5 years; p<0.01).

Chemotherapy induction followed by hematopoietic cell transplantation (HCT) was offered to 46 (n=179) of patients. In patients <65 years, HCT-based front-line regimens were associated with improved PFS compared with non-HCT regimens (median PFS: 86.2 vs. 40.0 months; p<0.01), with a trend toward longer OS (median OS: 165.0 vs. 120.0 months; p=0.06).

Patients who received therapy with ibrutinib experienced increased survival rates when given as second-line treatment compared with later lines of treatment (OS: hazard ratio [HR], 0.27; P <.01; PFS: HR, 0.52; P =.03).

The researchers concluded that their study demonstrates a continuing clinical need for novel therapeutic approaches particularly in patients with MCL with early treatment failure or who experience multiple relapses. 

Kumar A, et al. Blood Cancer Journal