IMPROVEMENTS IN OUTCOME OF MANTLE-CELL LYMPHOMA (MCL) ARE MOSTLY DUE TO ADVANCES IN INDUCTION THERAPY AND AUTOLOGOUS STEM-CELL TRANSPLANTATION (ASCT) - A REAL-LIFE NON-INTERVENTIONAL STUDY OF KROHEM
Author(s): ,
Igor Aurer
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Centre Zagreb,Zagreb,Croatia;Department of Internal Medicine,Medical School University of Zagreb,Zagreb,Croatia
,
Karla Misura-Jakobac
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Merkur,Zagreb,Croatia
,
Jasminka Sincic-Petricevic
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Centre Osijek,Osijek,Croatia
,
Dajana Deak
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Centre Sisters of Mercy,Zagreb,Croatia
,
Marijo Vodanovic
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Centre Zagreb,Zagreb,Croatia
,
Marinka Jakic-Bubalo
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Centre Split,Split,Croatia
,
Zdravko Mitrovic
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Dubrava,Zagreb,Croatia
,
Aron Grubesic
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Centre Rijeka,Rijeka,Croatia
,
Barbara Dreta
Affiliations:
Division of Hematology, Department of Internal Medicine,University Hospital Centre Zagreb,Zagreb,Croatia
,
Dubravka Zupanic-Krmek
Affiliations:
Department of Internal Medicine,University Hospital Holy Spirit,Zagreb,Croatia
Bozena Coha
Affiliations:
Department of Internal Medicine,General Hospital S. Brod,Slavonski Brod,Croatia
EHA Library. Aurer I. Jun 15, 2019; 266882; PS1265
Prof. Dr. Igor Aurer
Prof. Dr. Igor Aurer
Contributions
Abstract

Abstract: PS1265

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Outcome of patients with newly diagnosed MCL has improved substantially in the last decade. This coincided with the more frequent use of high-dose cytarabine (HD-AraC) and bendamustine (B) containing induction regimens, ASCT in first remission and rituximab (R) maintenance. Some real-life studies suggested that the latter was most important.

Aims
KroHem, the Croatian Cooperative Group for Hematologic Diseases initiated this study to analyze outcomes of patients with MCL who started treatment or were diagnosed between 2015 and 2017 (recent cohort), identify prognostic factors and compare the results to those of a historical cohort who started treatment between 2007 and 2008. 

Methods
This was a retrospective study including all patients with MCL fulfilling the entry criteria seen at participating centers during the defined periods.

Results
In the recent cohort 83 patients were treated, 2 received supportive care only and 5 had indolent disease and were observed. Median age was 68, 68% were male. All 40 patients in the historical cohort were treated, their median age was 67, 70% were male. All treated patients received R. Median follow up of the recent cohort was 20 mo and of the historical 39 mo. 2-year overall survival (OS) of treated patients increased from 57% to 81% and 2-year event free survival (EFS) from 41% to 57%. None of the indolent MCL patients progressed. MIPI, age and cytology were significant prognostic factors in the recent cohort for OS (p values 0.006, 0.006 and 0.013 respectively) and EFS (p values <0.001, 0.002 and 0.014 respectively). The difference in EFS between cohorts was more pronounced in patients below 65 (74% vs. 45% at 2 years) than in the elderly (41% vs. 39%) while OS improved in both age groups, but more in the younger (92% vs. 62% in younger and 70% vs. 51% in older patients at 2 years). Induction treatment and ASCT were statistically significant prognostic factors for EFS in the recent cohort. Patients treated with HD-AraC had the best outcomes, those treated with BR intermediate, while those receiving R-CHOP-like regimens fared worst (2-year EFS 80%, 61% and 38%, respectively; p=0.016). EFS of R-CHOP treatment patients did not differ between cohorts (38% in the recent vs. 42% in the historical cohort at 2 years). In the recent cohort 35% of patients with an EFS >6 mo received ASCT compared to 12.5% in the historical; outcome of transplanted patients was similar (2-year EFS 83% vs. 80%). In the recent cohort 44% patients with EFS >6 mo received R maintenance, this did not seem to have a major impact on either OS (p=0.993) or EFS (p=0,229).

Conclusion
Our data suggest that the use of HD-AraC and BR in induction and more widespread ASCT in first remission are most important factors contributing to the improvement in outcomes of newly diagnosed patients with MCL. The lack of prognostic significance of R maintenance is probably due to short follow-up.

Session topic: 18. Indolent and mantle-cell non-Hodgkin lymphoma - Clinical

Keyword(s): Autologous hematopoietic stem cell transplantation, Mantle cell lymphoma

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