Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.
BMC Cancer. 2021 May 17;21(1):566. doi: 10.1186/s12885-021-08326-1.
Significant progress has been made in the treatment outcomes of mantle cell lymphoma (MCL) since the introduction of cytarabine and rituximab in modern regimens. However, older patients may not readily tolerate these agents nor derive benefit. We investigated the impact of age on treatment patterns and clinical outcomes of MCL patients in an Asian population.
A retrospective study was conducted on patients (n = 66) diagnosed with MCL at the National Cancer Centre Singapore between 1998 and 2018. The median follow-up duration was 40 months. Survival analyses were performed using the Kaplan-Meier method and multivariate Cox proportional models.
The median age of the cohort was 59 years (range, 26-84), with a male predominance (73%). The majority (86%) had advanced stage 3-4 disease at diagnosis. Compared with younger patients, older patients aged ≥60 years (n = 32; 48.5%) presented more frequently with B-symptoms (75% vs 38%, p = 0.0028), anaemia (75% vs 35%, p = 0.0013), and carried higher prognostic risk scores (sMIPI high risk 84% vs 56%, p = 0.016). Non-cytarabine-based induction chemotherapy was more commonly administered in older patients (76% vs 32%, p = 0.0012). The 5-year overall survival (OS) and progression-free survival (PFS) was 68 and 25% respectively. In a multivariable model, older age (HR 3.42, 95%CI 1.48-7.92, p = 0.004) and anemia (HR 2.56, 95%CI 1.10-5.96, p = 0.029) were independently associated with poorer OS while older age (HR 2.24, 95%CI 1.21-4.14, p = 0.010) and hypoalbuminemia (HR 2.20, 95%CI 1.17-4.13, p = 0.014) were independently associated with poorer PFS. In an exploratory analysis, maintenance rituximab following induction chemotherapy improved PFS in younger patients, with median PFS of 131 months and 45 months with or without maintenance therapy respectively (HR 0.39, 95%CI 0.16-0.93, p = 0.035). In contrast, no survival benefit was observed in older patients.
We demonstrated in our analysis that older patients with MCL may harbor adverse clinical features and may not derive benefit from maintenance rituximab, highlighting the need for further research in this area of need.
自从阿糖胞苷和利妥昔单抗在现代方案中引入以来，套细胞淋巴瘤（MCL）的治疗结果取得了重大进展。然而，老年患者可能不易耐受这些药物，也无法从中获益。我们研究了年龄对亚洲人群 MCL 患者治疗模式和临床结局的影响。
对 1998 年至 2018 年期间在新加坡国家癌症中心诊断为 MCL 的 66 例患者（n=66）进行了回顾性研究。中位随访时间为 40 个月。使用 Kaplan-Meier 方法和多变量 Cox 比例模型进行生存分析。
该队列的中位年龄为 59 岁（范围 26-84），男性居多（73%）。大多数（86%）患者在诊断时处于晚期 3-4 期。与年轻患者相比，年龄≥60 岁的老年患者更常出现 B 症状（75% vs 38%，p=0.0028）、贫血（75% vs 35%，p=0.0013），且具有更高的预后风险评分（sMIPI 高危 84% vs 56%，p=0.016）。老年患者更常接受非阿糖胞苷为基础的诱导化疗（76% vs 32%，p=0.0012）。5 年总生存率（OS）和无进展生存率（PFS）分别为 68%和 25%。在多变量模型中，年龄较大（HR 3.42，95%CI 1.48-7.92，p=0.004）和贫血（HR 2.56，95%CI 1.10-5.96，p=0.029）与较差的 OS 独立相关，而年龄较大（HR 2.24，95%CI 1.21-4.14，p=0.010）和低白蛋白血症（HR 2.20，95%CI 1.17-4.13，p=0.014）与较差的 PFS 独立相关。在一项探索性分析中，诱导化疗后维持利妥昔单抗可改善年轻患者的 PFS，中位 PFS 分别为 131 个月和 45 个月（HR 0.39，95%CI 0.16-0.93，p=0.035）。相比之下，老年患者的生存获益未观察到。
我们的分析表明，MCL 老年患者可能具有不良的临床特征，并且可能无法从维持性利妥昔单抗中获益，这突出表明需要在这一需求领域进行进一步研究。
