Initial Treatment Patterns and Survival Outcomes of Mantle Cell Lymphoma Patients Managed at Chinese Academic Centers in the Rituximab Era: A Real-World Study

Meng Wu; Yun Li; Huiqiang Huang; Wei Xu; Yanyan Wang; Haiwen Huang; Weili Zhao; Shuo Liu; Pengpeng Xu; Zhengming Chen; Jun Zhu; Yuqin Song; Jia Ruan; Depei Wu

doi:10.3389/fonc.2021.770988

Initial Treatment Patterns and Survival Outcomes of Mantle Cell Lymphoma Patients Managed at Chinese Academic Centers in the Rituximab Era: A Real-World Study

Front Oncol. 2022 Jan 4:11:770988. doi: 10.3389/fonc.2021.770988. eCollection 2021.

Authors

Meng Wu¹, Yun Li^{2

3}, Huiqiang Huang⁴, Wei Xu⁵, Yanyan Wang⁶, Haiwen Huang^{2

3}, Weili Zhao⁶, Shuo Liu^{2

3}, Pengpeng Xu⁶, Zhengming Chen⁷, Jun Zhu¹, Yuqin Song¹, Jia Ruan⁷, Depei Wu^{2

3}

Affiliations

¹ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China.
² National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
³ Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
⁴ Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
⁵ Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
⁶ Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁷ Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, United States.

Abstract

Purpose: The aim of the study was to delineate the disease characteristics, the initial treatment patterns, and survival in patients with mantle cell lymphoma (MCL) managed in the real world.

Methods: Data of 518 MCL patients from 5 major Chinese Hematology Centers in the period from 2007 to 2017 were retrospectively analyzed.

Results: The median age was 58 years. Of the patients, 88.6% had Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1 and 80.7% had advanced-stage disease. Ki67 expression was <30% in 39.6% of the patients, and 43.2% of patients were categorized into a low-risk group based on the Mantle Cell Lymphoma International Prognostic Index (MIPI) scoring system. Overall, 73.4% of the patients received rituximab as their first-line therapy. The most commonly used chemotherapy was the CHOP-like (cyclophosphamide, hydroxydaunomycin, oncovin, and prednisone) regimen (45.2%), followed by high-dose cytarabine-containing chemotherapy (31.3%) and bendamustine (3.3%). Of the patients, 13.7% (n = 71) underwent consolidative autologous stem cell transplantation (ASCT), and 19.3% (n = 100) received novel agents containing first-line regimens. With a median follow-up time of 52 months, the 3- and 5-year overall survival (OS) rates were 73.7% and 61.4%, respectively. Age ≤60 years, ECOG PS 0-1, stages I-II, normal lactate dehydrogenase (LDH), absence of bone marrow involvement, Ki67 <30%, and lower-risk IPI/MIPI scores were significantly associated with improved OS (p < 0.05). The inclusion of rituximab improved the 5-year OS, with borderline significance (62.5% vs. 55.2%, p = 0.076). High-dose cytarabine-containing chemotherapy showed significant clinical benefit in 5-year OS (72.1% vs. 55.9%, p = 0.010). Patients with ASCT had better 5-year OS in the younger (≤60 years) age group (87.2% vs. 64.8%, p = 0.002).

Conclusion: This large retrospective dataset unequivocally confirmed the survival advantage afforded by cytarabine-containing regimen and ASCT in a first-line setting under real-world management in the rituximab era.

Keywords: initial treatment; mantle cell lymphoma; multicenter research; real-world data; the rituximab era.