Krithika Shanmugasundaram1, Subir Goyal2, Jeffery Switchenko2, Oscar Calzada3, Michael C Churnetski3, Bhaskar Kolla4, Veronika Bachanova4, James N Gerson5, Stefan K Barta5, Max J Gordon6, Alexey V Danilov6, Natalie S Grover7, Stephanie Mathews7, Madelyn Burkart8, Reem Karmali8, Yazeed Sawalha9, Brian T Hill9, Nilanjan Ghosh10, Steven I Park10, Narendranath Epperla11,12, David A Bond11, Talha Badar12, Kristie A Blum3, Mehdi Hamadani13, Timothy S Fenske13, Mary Malecek14, Brad S Kahl14, Peter Martin15, Jin Guo16, Christopher R Flowers16, Jonathon B Cohen3. 1. National Institutes of Health, National Cancer Institute, Bethesda, MD, US. 2. Winship Cancer Institute, Biostatistics and Bioinformatics, Emory University, Atlanta, GA, US. 3. Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University Hospital, Atlanta, GA, US. 4. Division of Hematology Oncology and Transplantation, University of Minnesota, Minneapolis, MN, US. 5. Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, US. 6. Knight Cancer Institute, Oregon Health and Science University, Portland, OR, US. 7. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, US. 8. Division of Hematology, Northwestern University, Chicago, IL, US. 9. Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, US. 10. Levine Cancer Institute, Charlotte, NC, US. 11. Division of Hematology, The Ohio State University Cancer Center, Columbus, OH, US. 12. Mayo Clinic, Jacksonville, FL, US. 13. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, US. 14. Siteman Cancer Center, Washington University, St. Louis, MO, US. 15. Weill Cornell Medicine, New York, NY, US. 16. Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US.
Abstract
INTRODUCTION: While most patients with mantle cell lymphoma (MCL) receive therapy shortly after diagnosis, a subset of patients with indolent-behaving disease can safely defer treatment. In this subgroup, we evaluated the importance of treatment intensity in patients with MCL who defer initial therapy. METHODS: Out of 1134 patients with MCL from 12 academic centers, we analyzed 219 patients who initiated therapy at least 90 days after diagnosis. Patients who received induction with high-dose cytarabine and/or autologous stem cell transplantation (ASCT) in first remission were considered to have received intensive therapy (n = 88) while all other approaches were non-intensive (n = 131). RESULTS: There was no difference in progression-free (PFS; P = .224) or overall survival (OS; P = .167) in deferred patients who received non-intensive vs. intensive therapy. Additionally, univariate and multivariate Cox proportional hazards models were performed for PFS and OS. Treatment at an academic center (HR 0.43, P = .015) was associated with improved OS in both univariate and multivariate models, while intensity of treatment was not associated with improved OS in either model. CONCLUSIONS: These results indicate that intensified initial treatment is not associated with improved survival after deferring initial therapy, although prospective studies are needed to determine which of these patients with MCL may benefit from intensive therapy.
INTRODUCTION: While most patients with mantle cell lymphoma (MCL) receive therapy shortly after diagnosis, a subset of patients with indolent-behaving disease can safely defer treatment. In this subgroup, we evaluated the importance of treatment intensity in patients with MCL who defer initial therapy. METHODS: Out of 1134 patients with MCL from 12 academic centers, we analyzed 219 patients who initiated therapy at least 90 days after diagnosis. Patients who received induction with high-dose cytarabine and/or autologous stem cell transplantation (ASCT) in first remission were considered to have received intensive therapy (n = 88) while all other approaches were non-intensive (n = 131). RESULTS: There was no difference in progression-free (PFS; P = .224) or overall survival (OS; P = .167) in deferred patients who received non-intensive vs. intensive therapy. Additionally, univariate and multivariate Cox proportional hazards models were performed for PFS and OS. Treatment at an academic center (HR 0.43, P = .015) was associated with improved OS in both univariate and multivariate models, while intensity of treatment was not associated with improved OS in either model. CONCLUSIONS: These results indicate that intensified initial treatment is not associated with improved survival after deferring initial therapy, although prospective studies are needed to determine which of these patients with MCL may benefit from intensive therapy.
Authors: Eva Hoster; Andreas Rosenwald; Françoise Berger; Heinz-Wolfram Bernd; Sylvia Hartmann; Christoph Loddenkemper; Thomas F E Barth; Nicole Brousse; Stefano Pileri; Grzegorz Rymkiewicz; Roman Kodet; Stephan Stilgenbauer; Roswitha Forstpointner; Catherine Thieblemont; Michael Hallek; Bertrand Coiffier; Ursula Vehling-Kaiser; Réda Bouabdallah; Lothar Kanz; Michael Pfreundschuh; Christian Schmidt; Vincent Ribrag; Wolfgang Hiddemann; Michael Unterhalt; Johanna C Kluin-Nelemans; Olivier Hermine; Martin H Dreyling; Wolfram Klapper Journal: J Clin Oncol Date: 2016-02-29 Impact factor: 44.544
Authors: James N Gerson; Elizabeth Handorf; Diego Villa; Alina S Gerrie; Parv Chapani; Shaoying Li; L Jeffrey Medeiros; Michael I Wang; Jonathon B Cohen; Oscar Calzada; Michael C Churnetski; Brian T Hill; Yazeed Sawalha; Francisco J Hernandez-Ilizaliturri; Shalin Kothari; Julie M Vose; Martin A Bast; Timothy S Fenske; Swapna Narayana Rao Gari; Kami J Maddocks; David Bond; Veronika Bachanova; Bhaskar Kolla; Julio Chavez; Bijal Shah; Frederick Lansigan; Timothy F Burns; Alexandra M Donovan; Nina Wagner-Johnston; Marcus Messmer; Amitkumar Mehta; Jennifer K Anderson; Nishitha Reddy; Alexandra E Kovach; Daniel J Landsburg; Martha Glenn; David J Inwards; Reem Karmali; Jason B Kaplan; Paolo F Caimi; Saurabh Rajguru; Andrew Evens; Andreas Klein; Elvira Umyarova; Bhargavi Pulluri; Jennifer E Amengual; Jennifer K Lue; Catherine Diefenbach; Richard I Fisher; Stefan K Barta Journal: J Clin Oncol Date: 2019-01-07 Impact factor: 44.544
Authors: Eva Hoster; Martin Dreyling; Wolfram Klapper; Christian Gisselbrecht; Achiel van Hoof; Hanneke C Kluin-Nelemans; Michael Pfreundschuh; Marcel Reiser; Bernd Metzner; Hermann Einsele; Norma Peter; Wolfram Jung; Bernhard Wörmann; Wolf-Dieter Ludwig; Ulrich Dührsen; Hartmut Eimermacher; Hannes Wandt; Joerg Hasford; Wolfgang Hiddemann; Michael Unterhalt Journal: Blood Date: 2007-10-25 Impact factor: 22.113
Authors: P Abrisqueta; D W Scott; G W Slack; C Steidl; A Mottok; R D Gascoyne; J M Connors; L H Sehn; K J Savage; A S Gerrie; D Villa Journal: Ann Oncol Date: 2017-10-01 Impact factor: 32.976