Real-World MCL Management Differs from Clinical Trials

Peter Martin, MD, associate professor of Medicine and chief of the Lymphoma Program at Weill Cornell Medicine, discusses questions asked in regards to patient populations in a real-world study of treatment patterns and outcomes of mantle cell lymphoma (MCL).

According to Martin and research reported on the Flatiron dataset, about 80% of patients came from community-based practices. The data helped researchers evaluate patterns of care to know what treatments are being applied, look at patient outcomes to see how well the patients fare when treated in general practice mostly outside of clinical trials, and learn more about the role of autologous stem cell transplantation in younger patients.

Based on guidelines and clinical trials reviewed prior, the results showed to be lower than expected with only about 40% of older patients treated with bendamustine/rituximab (Rituxan), and in younger patients, only about a quarter treated with cytarabine-based induction.

The outcomes of patients were also not consistent with the 5- to 7-year remission durations expected from clinical trials. The average time to next treatment in a 2-year timeframe in both older and younger patients was a little longer in younger patients and a little less than older patients. With this, the role of stem cell transplantation in clinical trials is being questioned.

Transcription:

0:08 | If we looked specifically at the population of patients that were called stem cell transplant-eligible, these were younger patients who did not initiate a second therapy within the first 6 months. We asked the question, if they got stem cell transplant, or they did not, how well do they do? Similarly, regardless of whether they got the stem cell transplant, it doesn't tell us that 1 treatment approach is better than another. The study is not designed to do that. But it does support the ongoing phase 3 trials that are asking the question of whether stem cell transplantation is necessary. That provides more rationale to support enrollment in those clinical trials, and it does support the development of clinical trials that don't necessarily include intensive therapy in younger patients.