Contributions
Abstract: PB1769
Type: Publication Only
Background
Most of the patients with MCL have an unfavorable prognosis. It is a heterogenous disease that remains incurable despite progress in therapies developed with quite heterogeneous approaches in frontline and relapse scenarios.
Aims
This retrospective, multicentre, observational study describes and analyses the therapeutic strategies and their results in MCL from first line and beyond in routine clinical practice in Spain.
Methods
Patients included were diagnosed since 2005, older than 18 years with
relapsed/refractory MCL and followed during a minimum of 6 months after the last treatment received. Quantitative variables were described by measures of central tendency and dispersion and qualitative variables by absolute and relative frequencies. Survival analysis were made by Kaplan-Meier Method. Analysis done with SPSS v18.0
Results
Primary endpoint: efficacy of treatments in terms of response, progression free and overall survival. Secondary endpoints: Description of demographic characteristics, morbidities, treatments and safety profile. 67 patients were analysed: 43 not candidates and 24 candidates to intensive therapy at diagnosis. Median age was 71 (range, 42-90 yo), blastoid histology 40%, 93% extranodal disease (86% bone marrow, 48% gastrointestinal) and 40% high-MIPI. Comorbidities: hypertension (43%), cardiovascular disease (40%), AF/Flutter (18%), thrombosis (12%) and liver disease (12%). Most concomitant treatments were: antihypertensive therapy 45%, antidepressants 38%, anticoagulants 34% and 24% antiplatelet agents. Treatment decisions were made by: routine clinical practice (2/3), clinical protocol (1/3). None treatment was discarded due to economic issues. Main treatments in first line were: R-CHOP (54%), R-HyperCVAD or R-CHOP/R-DHAP (39%), R-CVP (5%) and R-Bendamustine (3%), 19% received rituximab maintenance and 18% ASCT. For second line: R-Bendamustine (30%) and R-GemOX (19%), 21% patients received rituximab maintenance, 5% ASCT and 5% alloSCT. The rest were highly variable. For third line: R-Bendamustine (29%), ibrutinib (16%), temsirolimus (11%), radiotherapy (11%), 2% ASCT and 4% alloSCT. In 4th line, R-Bendamustine (33%), bortezomib combinations (25%) and ibrutinib (13%). Survival results with every line according to non-candidates /candidates to intensive therapy are shown in the table below.
Conclusion
This study shows the highly heterogenous treatments in MCL in a sanitary scenario without economic restrictions. Overall survival differs according to intensive versus non intensive treatment in first line and, it markedly decreases from the second line onwards, especially in older patients. We need new therapeutic targets to improve the current outcomes.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Mantle cell lymphoma
Abstract: PB1769
Type: Publication Only
Background
Most of the patients with MCL have an unfavorable prognosis. It is a heterogenous disease that remains incurable despite progress in therapies developed with quite heterogeneous approaches in frontline and relapse scenarios.
Aims
This retrospective, multicentre, observational study describes and analyses the therapeutic strategies and their results in MCL from first line and beyond in routine clinical practice in Spain.
Methods
Patients included were diagnosed since 2005, older than 18 years with
relapsed/refractory MCL and followed during a minimum of 6 months after the last treatment received. Quantitative variables were described by measures of central tendency and dispersion and qualitative variables by absolute and relative frequencies. Survival analysis were made by Kaplan-Meier Method. Analysis done with SPSS v18.0
Results
Primary endpoint: efficacy of treatments in terms of response, progression free and overall survival. Secondary endpoints: Description of demographic characteristics, morbidities, treatments and safety profile. 67 patients were analysed: 43 not candidates and 24 candidates to intensive therapy at diagnosis. Median age was 71 (range, 42-90 yo), blastoid histology 40%, 93% extranodal disease (86% bone marrow, 48% gastrointestinal) and 40% high-MIPI. Comorbidities: hypertension (43%), cardiovascular disease (40%), AF/Flutter (18%), thrombosis (12%) and liver disease (12%). Most concomitant treatments were: antihypertensive therapy 45%, antidepressants 38%, anticoagulants 34% and 24% antiplatelet agents. Treatment decisions were made by: routine clinical practice (2/3), clinical protocol (1/3). None treatment was discarded due to economic issues. Main treatments in first line were: R-CHOP (54%), R-HyperCVAD or R-CHOP/R-DHAP (39%), R-CVP (5%) and R-Bendamustine (3%), 19% received rituximab maintenance and 18% ASCT. For second line: R-Bendamustine (30%) and R-GemOX (19%), 21% patients received rituximab maintenance, 5% ASCT and 5% alloSCT. The rest were highly variable. For third line: R-Bendamustine (29%), ibrutinib (16%), temsirolimus (11%), radiotherapy (11%), 2% ASCT and 4% alloSCT. In 4th line, R-Bendamustine (33%), bortezomib combinations (25%) and ibrutinib (13%). Survival results with every line according to non-candidates /candidates to intensive therapy are shown in the table below.
Conclusion
This study shows the highly heterogenous treatments in MCL in a sanitary scenario without economic restrictions. Overall survival differs according to intensive versus non intensive treatment in first line and, it markedly decreases from the second line onwards, especially in older patients. We need new therapeutic targets to improve the current outcomes.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Mantle cell lymphoma