Contributions
Type: Publication Only
Background
No large scale description of sequential treatment (tx) lines and time to the next treatment (TTNT) exists for mantle cell lymphoma (MCL).
Aims
This study evaluated first, second, and third tx lines (1L/2L/3L) and TTNT for US patients in the usual care setting.
Methods
MCL patients (pts) were identified from the IMS PharMetrics Plus database (>100 million US pts) having ≥2 medical claims (ICD-9-CM 200.4x) at least 30 days apart in 2008-2012 (the first diagnosis date as the index), no MCL claims in the 6 months pre-index and continuous enrollment in the health plans for ≥3 months post-index. The 1L therapy was defined as all MCL tx administered within 90 days of tx start. A new tx line was defined as addition of a new agent ≥90 days from tx start, or when tx was restarted following a 90 day gap in therapy. For ASCT pts, TTNT to 2L was the duration from ASCT procedure date to the start of subsequent tx; for non-ASCT patients and ASCT pts post-2L, TTNT was the time between the initiation of current line tx to the beginning of next line tx. Rituximab (R) monotherapy was not considered a new tx line when initiated within 12 months post any tx line.
Results
Of the 872 pts in the study, 172 (19.7%) received ASCT, 628 (72.0%) were males and mean age was 63.3 years. Comparison between transplanted and non-transplanted pts revealed ASCT pts were younger (median: 56.8 vs 64.9 years). Compared to non-transplanted pts, ASCT pts had also fewer comorbidities calculated by Charlson Comorbidity Index (mean: 1.63 vs 2.44).
Within 1L, the majority (52.9%) of ASCT pts received tx regimens containing anthracycline + R, followed by regimens containing cyclophosphamide or vincristine +/- R (18.6%). The most frequent 1L tx regimens for non-ASCT pts were anthracycline +/- R (30.7%), R monotherapy (19.9%) and bendamustine +/- R (13.9%). The most common tx regimens in 2L contained R monotherapy (32.3%), bendamustine +/- R (21.9%), bortezomib +/- R (16.8%) and other chemotherapy +/- R (24.3%), and the most common regimens in 3L contained bendamustine +/- R (29.4%), R monotherapy (20.2%), bortezomib +/- R (14.3%), and other chemotherapy +/- R (23.5%).
Of the pts not followed to TTNT (n=538), median follow-up time in days was 517 from the start of 1L tx, 304 from 2L tx, and 243 from 3L tx. The median TTNT to 2L was 349.5 days for pts who relapsed after ASCT (n=54) and 421.5 days for relapsed non-ASCT pts (n=280). For all relapsed/refractory pts, median TTNT was 403.5 days from 1L to 2L (334 pts); 272 days from 2L to 3L (119 pts), and 213 days from 3L to 4L (41 pts).
Summary
Within each tx line, there was substantial variation in treatment regimens. The decreasing interval from one line of therapy to the next line of therapy suggests that once patients relapse, they deteriorate at an increasing pace. Taken together, the current results suggest an unmet need exists for effective treatment of patients that relapse.
Keyword(s): Mantle cell lymphoma
Session topic: Publication Only
Type: Publication Only
Background
No large scale description of sequential treatment (tx) lines and time to the next treatment (TTNT) exists for mantle cell lymphoma (MCL).
Aims
This study evaluated first, second, and third tx lines (1L/2L/3L) and TTNT for US patients in the usual care setting.
Methods
MCL patients (pts) were identified from the IMS PharMetrics Plus database (>100 million US pts) having ≥2 medical claims (ICD-9-CM 200.4x) at least 30 days apart in 2008-2012 (the first diagnosis date as the index), no MCL claims in the 6 months pre-index and continuous enrollment in the health plans for ≥3 months post-index. The 1L therapy was defined as all MCL tx administered within 90 days of tx start. A new tx line was defined as addition of a new agent ≥90 days from tx start, or when tx was restarted following a 90 day gap in therapy. For ASCT pts, TTNT to 2L was the duration from ASCT procedure date to the start of subsequent tx; for non-ASCT patients and ASCT pts post-2L, TTNT was the time between the initiation of current line tx to the beginning of next line tx. Rituximab (R) monotherapy was not considered a new tx line when initiated within 12 months post any tx line.
Results
Of the 872 pts in the study, 172 (19.7%) received ASCT, 628 (72.0%) were males and mean age was 63.3 years. Comparison between transplanted and non-transplanted pts revealed ASCT pts were younger (median: 56.8 vs 64.9 years). Compared to non-transplanted pts, ASCT pts had also fewer comorbidities calculated by Charlson Comorbidity Index (mean: 1.63 vs 2.44).
Within 1L, the majority (52.9%) of ASCT pts received tx regimens containing anthracycline + R, followed by regimens containing cyclophosphamide or vincristine +/- R (18.6%). The most frequent 1L tx regimens for non-ASCT pts were anthracycline +/- R (30.7%), R monotherapy (19.9%) and bendamustine +/- R (13.9%). The most common tx regimens in 2L contained R monotherapy (32.3%), bendamustine +/- R (21.9%), bortezomib +/- R (16.8%) and other chemotherapy +/- R (24.3%), and the most common regimens in 3L contained bendamustine +/- R (29.4%), R monotherapy (20.2%), bortezomib +/- R (14.3%), and other chemotherapy +/- R (23.5%).
Of the pts not followed to TTNT (n=538), median follow-up time in days was 517 from the start of 1L tx, 304 from 2L tx, and 243 from 3L tx. The median TTNT to 2L was 349.5 days for pts who relapsed after ASCT (n=54) and 421.5 days for relapsed non-ASCT pts (n=280). For all relapsed/refractory pts, median TTNT was 403.5 days from 1L to 2L (334 pts); 272 days from 2L to 3L (119 pts), and 213 days from 3L to 4L (41 pts).
Summary
Within each tx line, there was substantial variation in treatment regimens. The decreasing interval from one line of therapy to the next line of therapy suggests that once patients relapse, they deteriorate at an increasing pace. Taken together, the current results suggest an unmet need exists for effective treatment of patients that relapse.
Keyword(s): Mantle cell lymphoma
Session topic: Publication Only