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Multicenter Study
. 2021 Sep;107(3):301-310.
doi: 10.1111/ejh.13649. Epub 2021 Jun 17.

Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival

Krithika Shanmugasundaram  1 , Subir Goyal  2 , Jeffery Switchenko  2 , Oscar Calzada  3 , Michael C Churnetski  3 , Bhaskar Kolla  4 , Veronika Bachanova  4 , James N Gerson  5 , Stefan K Barta  5 , Max J Gordon  6 , Alexey V Danilov  6 , Natalie S Grover  7 , Stephanie Mathews  7 , Madelyn Burkart  8 , Reem Karmali  8 , Yazeed Sawalha  9 , Brian T Hill  9 , Nilanjan Ghosh  10 , Steven I Park  10 , Narendranath Epperla  11   12 , David A Bond  11 , Talha Badar  12 , Kristie A Blum  3 , Mehdi Hamadani  13 , Timothy S Fenske  13 , Mary Malecek  14 , Brad S Kahl  14 , Peter Martin  15 , Jin Guo  16 , Christopher R Flowers  16 , Jonathon B Cohen  3
Affiliations
Multicenter Study

Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival

Krithika Shanmugasundaram et al. Eur J Haematol. 2021 Sep.

Abstract

Introduction: While most patients with mantle cell lymphoma (MCL) receive therapy shortly after diagnosis, a subset of patients with indolent-behaving disease can safely defer treatment. In this subgroup, we evaluated the importance of treatment intensity in patients with MCL who defer initial therapy.

Methods: Out of 1134 patients with MCL from 12 academic centers, we analyzed 219 patients who initiated therapy at least 90 days after diagnosis. Patients who received induction with high-dose cytarabine and/or autologous stem cell transplantation (ASCT) in first remission were considered to have received intensive therapy (n = 88) while all other approaches were non-intensive (n = 131).

Results: There was no difference in progression-free (PFS; P = .224) or overall survival (OS; P = .167) in deferred patients who received non-intensive vs. intensive therapy. Additionally, univariate and multivariate Cox proportional hazards models were performed for PFS and OS. Treatment at an academic center (HR 0.43, P = .015) was associated with improved OS in both univariate and multivariate models, while intensity of treatment was not associated with improved OS in either model.

Conclusions: These results indicate that intensified initial treatment is not associated with improved survival after deferring initial therapy, although prospective studies are needed to determine which of these patients with MCL may benefit from intensive therapy.

Keywords: deferred; intensive therapy; mantle cell lymphoma; time to treatment.

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Figures

FIGURE 1
FIGURE 1
Overall surviva for MCL patients based on receipt of deferred therapy
FIGURE 2
FIGURE 2
Overall survival (A,B) and progression-free survival (C) in patients that deferred therapy based on intensity of therapy
See this image and copyright information in PMC

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