Stem Cell Transplantation May Be Offered Less Often as a Treatment Option for Some Patients with Mantle Cell Lymphoma

Some groups of patients with mantle cell lymphoma were less likely to be treated with autologous hematopoietic cell transplantation, particularly those who were never married, patients with more comorbidities and those with fewer years of education, according to a study published in Blood Advances.

“This calls for the need of a more informed decision making in relation to not only the patients’ health prior to (autologous hematopoietic cell transplantation) but also their sociodemographic situation,” the study authors wrote. “In case an (autologous hematopoietic cell transplantation) is deemed impossible, integration of novel treatment concepts (eg, tyrosine kinase inhibitors and bcl-2 inhibitors) instead or in combination with standard treatment is needed.”

As outcomes improve in younger patients with mantle cell lymphoma who are intensively treated, the disease is still the main cause of death in young patients, according to the introduction of the study. Elderly patients with mantle cell lymphoma have worse survival rates. With this study, researchers aimed to see whether certain demographic- and disease-related factors require more novel treatment concepts compared with others.

To do so, researchers assessed data from 369 patients ages 18 to 65 years who were diagnosed with mantle cell lymphoma between 2000 and 2015. They compared the likelihood of a patient undergoing autologous hematopoietic cell transplantation within an 18-month period after diagnosis despite the fact that the transplantation can be performed at different points after receiving a diagnosis of mantle cell lymphoma.

Of the patients in the study, 40% were not treated with autologous hematopoietic cell transplantation within the 18-month period after receiving their diagnosis. Patients who were never married or divorced, compared with those who were married, were less likely to undergo autologous hematopoietic cell transplantation. This was also seen in patients with lower educational levels and those with comorbidities.

Patients who underwent autologous hematopoietic cell transplantation were less likely to die from any cause. Death related to the transplant itself occurred in 2% of patients. Those who did not receive an autologous hematopoietic cell transplantation had an increased mortality rate. There was also unwarranted concern about performing autologous hematopoietic cell transplantation in certain societal groups, according to the researchers.

“This had prognostic implications, and it calls for improvements in both supportive functions and clinicians’ awareness about their decisions to potentially make more patients eligible for an (autologous hematopoietic cell transplantation),” the study authors wrote. “For frail patients, our results also call for introduction of alternative, more tolerable treatments for a large fraction of (mantle cell lymphoma) patients, which in turn may improve survival.”

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