Improvements in Outcomes in Older Patients With Mantle Cell Lymphoma Are Associated With Improvements Across Multiple...

Survival in mantle cell lymphoma (MCL) has improved over time, with 1 potential reason being approval of new therapies. We hypothesized that access to multiple new agents with nonoverlapping mechanisms of action would result in significant improvements in overall survival.

Patients ages > 65 and diagnosed with MCL between 2002 and 2019 were identified using the SEER-Medicare linked database. Lines of therapy were determined using billing codes. Overall survival 1 (OS1) was defined as time of initial therapy to death, while OS2 was defined as time of second-line therapy to death. Time to next therapy (TTNT) was defined as time from first-line therapy to death or start of second-line therapy. Analyses were stratified by both year of diagnosis and year of treatment categories.

In total, 5,441 patients were included; 4,382 patients (79.5%) had claims for first-line regimens and 1,538 (34.1%) for second-line regimens. In the first-line, use of rituximab-bendamustine (BR) increased from < 2% of patients diagnosed between 2002 and 2005 to 54% between 2014 and 2019. BTK-inhibitor (BTKi)-containing regimens, approved in 2013 for use in the second-line, accounted for 8% of first-line and 54% of second-line regimens among those diagnosed between 2014 and 2019. OS1 was significantly improved across year of diagnosis categories (P < .0001), with improvements also seen in TTNT and OS2.

We observed improvements in both OS1 and TTNT over time, which may correlate with increased BR and BTKi use as first-line agents. Unexpectedly, OS2 improvements were more modest. These data support the need for continued development of new therapies in MCL.