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

Abstract

Studies on late effects in patients with mantle cell lymphoma (MCL) are becoming increasingly important as survival is improving, and novel targeted drugs are being introduced. However, knowledge about late effects is limited. The aim of this population-based study was to describe the magnitude and panorama of late effects among patients treated with or without high-dose chemotherapy with autologous stem cell transplantation (HD-ASCT). The study cohort included all patients with MCL, recorded in the Swedish Lymphoma Register, aged 18 to 69 years, diagnosed between 2000 and 2014 (N = 620; treated with HD-ASCT, n = 247) and 1:10 matched healthy comparators. Patients and comparators were followed up via the National Patient Register and Cause of Death Register, from 12 months after diagnosis or matching to December 2017. Incidence rate ratios of the numbers of outpatient visits, hospitalizations, and bed days were estimated using negative binomial regression models. In relation to the matched comparators, the rate of specialist and hospital visits was significantly higher among patients with MCL. Patients with MCL had especially high relative risks of infectious, respiratory, and blood disorders. Within this observation period, no difference in the rate of these complications, including secondary neoplasms, was observed between patients treated with and without HD-ASCT. Most of the patients died from their lymphoma and not from another cause or treatment complication. Taken together, our results imply that most of the posttreatment health care needs are related to the lymphoma disease itself, thus, indicating the need for more efficient treatment options.

Figure 1.

Proportion of patients treated with HD-ASCT with an ICD-specific diagnosis at hospitalization or death within 60 days. Proportion of patients with MCL who were treated with HD-ASCT (within 12 months of diagnosis, n = 247) with an ICD chapter–specific diagnosis at hospitalization (blue) or death due to any cause (red), within the first 60 days of transplantation.

Figure 2.

Comparisons of rates of different ICD-chapters between MCL patients (by HD-ASCT treatment) and comparators. Hazard ratios with 95% CIs of first ICD chapter–specific diagnosis (specialist outpatient visits or hospitalization) or death among patients with MCL (by HD-ASCT [blue circles] or non-HD-ASCT [red dimonds]) and comparators (green squares). All models were adjusted for age at diagnosis, sex, calendar year, CCI, and educational level. CNS, central nervous system.

Figure 3.

Crude and standardized cumulative probabilities of death due to different causes by HD-ASCT. Cumulative probabilities of death portioned into MCL, other malignancies, cardiovascular disease (CVD), and other causes, within 12 months from diagnosis among patients with MCL, by without HD-ASCT (A,C) and with HD-ASCT (B,D). Crude estimates (A,B) and standardized estimates (C,D) over age, sex, CCI, and education level are shown. ∗Include ICD-10: C83-C91.