In patients with mantle cell lymphoma, rates of respiratory disease, blood disorders, and infectious diseases do not vary according to the intensity of treatment given, the results of a large retrospective analysis suggested.
The rate of hospitalization among MCL patients was also high, but again, did not differ between ASCT and non-ASCT subgroups in the study, which included adult patients younger than age 70 with MCL who were treated in Sweden between 2000 and 2014.
Late effects independent of ASCT
These findings may have implications for clinicians tempted to avoid intensive first-line treatment including ASCT because it is “demanding” and may cause late effects, study authors wrote in a research article that appeared in Blood Advances.
Dr. Ingrid Glimelius
In fact, the great majority of long-term health care needs in patients with MCL appear to be related to the lymphoma in itself, according to study senior author Ingrid Glimelius, MD, PhD, senior consultant and professor in oncology in the department of immunology, genetics, and pathology at Uppsala University in Sweden.
“You do have to keep your eyes open for complications like blood disorders, infections, and respiratory (disorders),” Dr. Glimelius said in an interview. “But it’s not the transplant that adds to the extra toxicity. So don’t be afraid of giving that, if you think that can prolong your patient’s remission.”
Whither transplantation?
While these data may advance the discussion over the relative safety of ASCT, she added, the paradigm is changing to ask a different question: Does the patient need a transplant, or not?
Dr. Glimelius said she was looking forward to results of TRIANGLE, a randomized, open-label, three-arm study initiated by the European MCL Network. This study compares standard first-line treatment including ASCT to the kinase inhibitor ibrutinib, which the U.S. Food and Drug Administration approved in 2013 for patients previously treated for MCL.
In the TRIANGLE study, younger patients with MCL were randomized to the standard first-line treatment, standard treatment plus ibrutinib, or ibrutinib alone.
A preliminary report on the study stated that the current standard is “not superior” to the new ibrutinib-containing regimen without ASCT, though more follow-up is needed.
Full results of the study are expected to be presented at the American Society of Hematology meeting on December 11.
“In my opinion, our data will be practice-changing,” said lead investigator Martin Dreyling, MD, PhD, professor of medicine and head of the lymphoma program at the University of Munich Hospital.
Little known about late effects
In the meantime, clinicians may be reassured by the current data from Dr. Glimelius and coauthors, which showed that late effects varied little by treatment choice.
That’s important, Dr. Glimelius said, because even as survival is improving and novel targeted drugs are taking the stage, knowledge about the late effects of MCL remains limited.
Their population-based study included all 620 patients with MCL in the Swedish Lymphoma Register who were 18-69 years of age and diagnosed between 2000 and 2014. Records were found for 620 patients, of whom 247 received high-dose chemotherapy with ASCT.
Compared with healthy individuals with no MCL, the patients with MCL had a high rate of specialist visits and hospital visits, according to the report. The MCL patients also had high risks of infections, respiratory complications, and blood disorders relative to the healthy subjects.