Improvements in Outcomes in Older Patients With Mantle Cell Lymphoma Are Associated With Improvements Across Multiple Lines of Therapy.

Abstract

Background: Survival in mantle cell lymphoma (MCL) has improved over time, with 1 potential reason being approval of new therapies. We hypothesized that access to multiple new agents with nonoverlapping mechanisms of action would result in significant improvements in overall survival.

Patients and methods: Patients ages > 65 and diagnosed with MCL between 2002 and 2019 were identified using the SEER-Medicare linked database. Lines of therapy were determined using billing codes. Overall survival 1 (OS1) was defined as time of initial therapy to death, while OS2 was defined as time of second-line therapy to death. Time to next therapy (TTNT) was defined as time from first-line therapy to death or start of second-line therapy. Analyses were stratified by both year of diagnosis and year of treatment categories.

Results: In total, 5,441 patients were included; 4,382 patients (79.5%) had claims for first-line regimens and 1,538 (34.1%) for second-line regimens. In the first-line, use of rituximab-bendamustine (BR) increased from < 2% of patients diagnosed between 2002 and 2005 to 54% between 2014 and 2019. BTK-inhibitor (BTKi)-containing regimens, approved in 2013 for use in the second-line, accounted for 8% of first-line and 54% of second-line regimens among those diagnosed between 2014 and 2019. OS1 was significantly improved across year of diagnosis categories (P < .0001), with improvements also seen in TTNT and OS2.

Conclusion: We observed improvements in both OS1 and TTNT over time, which may correlate with increased BR and BTKi use as first-line agents. Unexpectedly, OS2 improvements were more modest. These data support the need for continued development of new therapies in MCL.