Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY.
Department of Hematology, Winship Cancer Institute, Emory University, Atlanta, GA.
J Clin Oncol. 2023 Jan 20;41(3):541-554. doi: 10.1200/JCO.21.02698. Epub 2022 Jun 28.
Commonly used first-line (1L) treatments for mantle cell lymphoma include high-dose cytarabine-based induction followed by autologous stem-cell transplant (ASCT) for younger patients and several chemoimmunotherapy regimens for older patients. Continuous debates exist on the role of ASCT in younger patients and maintenance rituximab (MR) after bendamustine plus rituximab (BR).
Retrospective data from 4,216 patients with mantle cell lymphoma in the Flatiron Health electronic record-derived deidentified database diagnosed between 2011 and 2021, mostly in US community oncology settings, were evaluated for treatment patterns and outcomes. The efficacy findings with ASCT and MR were validated in an independent cohort of 1,168 patients from 12 academic centers.
Among 3,614 patients with documented 1L treatment, BR was the most used. Among 1,265 patients age < 65 years, 30.5% received cytarabine-based induction and 23.5% received ASCT. There was no significant association between ASCT and real-world time to next treatment (hazard ratio [HR], 0.84; 95% CI, 0.68 to 1.03; = .10) or overall survival (HR, 0.86; 95% CI, 0.63 to 1.18; = .4) among ASCT-eligible patients. Among MR-eligible patients, MR after BR versus BR alone was associated with a longer real-world time to next treatment (HR, 1.96; 95% CI, 1.61 to 2.38; < .001) and overall survival (HR, 1.51; 95% CI, 1.19 to 1.92; < .001). The efficacy findings were consistent in the validation cohort.
In this large cohort of patients treated primarily in the US community setting, only one in four young patients received cytarabine or ASCT consolidation, suggesting the need to develop treatments that can be delivered effectively in routine clinical practice. Together with the validation cohort, data support future clinical trials exploring regimens without ASCT consolidation in young patients, whereas MR should be considered for patients after 1L BR and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.
套细胞淋巴瘤的常用一线（1L）治疗方法包括大剂量阿糖胞苷为基础的诱导，随后进行自体干细胞移植（ASCT），适用于年轻患者，以及几种化疗免疫治疗方案，适用于老年患者。对于年轻患者的 ASCT 作用和苯达莫司汀联合利妥昔单抗（BR）后的维持利妥昔单抗（MR），一直存在持续的争论。
在 2011 年至 2021 年期间，从 Flatiron Health 电子病历中获得的匿名数据库中评估了 4216 名套细胞淋巴瘤患者的回顾性数据，这些患者主要在美国家庭肿瘤学环境中接受治疗，以评估治疗模式和结果。在来自 12 个学术中心的 1168 名患者的独立队列中验证了 ASCT 和 MR 的疗效发现。
在有记录的 1L 治疗的 3614 名患者中，BR 是最常用的治疗方法。在 1265 名年龄<65 岁的患者中，30.5%接受了阿糖胞苷为基础的诱导，23.5%接受了 ASCT。在有资格接受 ASCT 的患者中，ASCT 与真实世界的下一次治疗时间（风险比 [HR]，0.84；95%置信区间，0.68 至 1.03； =.10）或总生存（HR，0.86；95%置信区间，0.63 至 1.18； =.4）之间没有显著关联。在有资格接受 MR 的患者中，与 BR 单药治疗相比，BR 后接受 MR 与更长的真实世界下一次治疗时间（HR，1.96；95%置信区间，1.61 至 2.38； <.001）和总生存（HR，1.51；95%置信区间，1.19 至 1.92； <.001）相关。验证队列中的结果一致。
在这项针对主要在美国社区环境中接受治疗的大量患者的研究中，只有四分之一的年轻患者接受了阿糖胞苷或 ASCT 巩固治疗，这表明需要开发能够在常规临床实践中有效实施的治疗方法。与验证队列一起，数据支持未来探索年轻患者中无 ASCT 巩固治疗方案的临床试验，而对于接受 1L BR 和利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松治疗的患者，应考虑 MR。
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