Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival

Krithika Shanmugasundaram; Subir Goyal; Jeffery Switchenko; Oscar Calzada; Michael C. Churnetski; Bhaskar Kolla; Veronika Bachanova; James N. Gerson; Stefan K. Barta; Max J. Gordon; Alexey V. Danilov; Natalie S. Grover; Stephanie Mathews; Madelyn Burkart; Reem Karmali; Yazeed Sawalha; Brian T. Hill; Nilanjan Ghosh; Steven I. Park; Narendranath Epperla; David A. Bond; Talha Badar; Kristie A. Blum; Mehdi Hamadani; Timothy S. Fenske; Mary Malecek; Brad S. Kahl; Peter Martin; Jin Guo; Christopher R. Flowers; Jonathon B. Cohen

doi:10.1111/ejh.13649

Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival

Krithika Shanmugasundaram, Subir Goyal, Jeffery Switchenko, Oscar Calzada, Michael C. Churnetski, Bhaskar Kolla, Veronika Bachanova, James N. Gerson, Stefan K. Barta, Max J. Gordon, Alexey V. Danilov, Natalie S. Grover, Stephanie Mathews, Madelyn Burkart, Reem Karmali, Yazeed Sawalha, Brian T. Hill, Nilanjan Ghosh, Steven I. Park, Narendranath EpperlaDavid A. Bond, Talha Badar, Kristie A. Blum, Mehdi Hamadani, Timothy S. Fenske, Mary Malecek, Brad S. Kahl, Peter Martin, Jin Guo, Christopher R. Flowers, Jonathon B. Cohen^*

^*Corresponding author for this work

Medicine, Hematology Oncology Division

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

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.

Original language	English (US)
Pages (from-to)	301-310
Number of pages	10
Journal	European Journal of Haematology
Volume	107
Issue number	3
DOIs	https://doi.org/10.1111/ejh.13649
State	Published - Sep 2021

Funding

Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and the National Cancer Institute under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

deferred
intensive therapy
mantle cell lymphoma
time to treatment

ASJC Scopus subject areas

Hematology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/ejh.13649

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Shanmugasundaram, K., Goyal, S., Switchenko, J., Calzada, O., Churnetski, M. C., Kolla, B., Bachanova, V., Gerson, J. N., Barta, S. K., Gordon, M. J., Danilov, A. V., Grover, N. S., Mathews, S., Burkart, M., Karmali, R., Sawalha, Y., Hill, B. T., Ghosh, N., Park, S. I., ... Cohen, J. B. (2021). Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival. European Journal of Haematology, 107(3), 301-310. https://doi.org/10.1111/ejh.13649

@article{2384960aafff4afcb98a3c7266aa6130,

title = "Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival",

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.",

keywords = "deferred, intensive therapy, mantle cell lymphoma, time to treatment",

author = "Krithika Shanmugasundaram and Subir Goyal and Jeffery Switchenko and Oscar Calzada and Churnetski, {Michael C.} and Bhaskar Kolla and Veronika Bachanova and Gerson, {James N.} and Barta, {Stefan K.} and Gordon, {Max J.} and Danilov, {Alexey V.} and Grover, {Natalie S.} and Stephanie Mathews and Madelyn Burkart and Reem Karmali and Yazeed Sawalha and Hill, {Brian T.} and Nilanjan Ghosh and Park, {Steven I.} and Narendranath Epperla and Bond, {David A.} and Talha Badar and Blum, {Kristie A.} and Mehdi Hamadani and Fenske, {Timothy S.} and Mary Malecek and Kahl, {Brad S.} and Peter Martin and Jin Guo and Flowers, {Christopher R.} and Cohen, {Jonathon B.}",

note = "Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and the National Cancer Institute under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",

year = "2021",

month = sep,

doi = "10.1111/ejh.13649",

language = "English (US)",

volume = "107",

pages = "301--310",

journal = "European Journal of Haematology",

issn = "0902-4441",

publisher = "John Wiley and Sons Inc.",

number = "3",

}

Shanmugasundaram, K, Goyal, S, Switchenko, J, Calzada, O, Churnetski, MC, Kolla, B, Bachanova, V, Gerson, JN, Barta, SK, Gordon, MJ, Danilov, AV, Grover, NS, Mathews, S, Burkart, M, Karmali, R, Sawalha, Y, Hill, BT, Ghosh, N, Park, SI, Epperla, N, Bond, DA, Badar, T, Blum, KA, Hamadani, M, Fenske, TS, Malecek, M, Kahl, BS, Martin, P, Guo, J, Flowers, CR & Cohen, JB 2021, 'Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival', European Journal of Haematology, vol. 107, no. 3, pp. 301-310. https://doi.org/10.1111/ejh.13649

TY - JOUR

T1 - Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival

AU - Shanmugasundaram, Krithika

AU - Goyal, Subir

AU - Switchenko, Jeffery

AU - Calzada, Oscar

AU - Churnetski, Michael C.

AU - Kolla, Bhaskar

AU - Bachanova, Veronika

AU - Gerson, James N.

AU - Barta, Stefan K.

AU - Gordon, Max J.

AU - Danilov, Alexey V.

AU - Grover, Natalie S.

AU - Mathews, Stephanie

AU - Burkart, Madelyn

AU - Karmali, Reem

AU - Sawalha, Yazeed

AU - Hill, Brian T.

AU - Ghosh, Nilanjan

AU - Park, Steven I.

AU - Epperla, Narendranath

AU - Bond, David A.

AU - Badar, Talha

AU - Blum, Kristie A.

AU - Hamadani, Mehdi

AU - Fenske, Timothy S.

AU - Malecek, Mary

AU - Kahl, Brad S.

AU - Martin, Peter

AU - Guo, Jin

AU - Flowers, Christopher R.

AU - Cohen, Jonathon B.

N1 - Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and the National Cancer Institute under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

PY - 2021/9

Y1 - 2021/9

N2 - 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.

AB - 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.

KW - deferred

KW - intensive therapy

KW - mantle cell lymphoma

KW - time to treatment

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UR - http://www.scopus.com/inward/citedby.url?scp=85108117542&partnerID=8YFLogxK

U2 - 10.1111/ejh.13649

DO - 10.1111/ejh.13649

M3 - Article

C2 - 33973276

AN - SCOPUS:85108117542

SN - 0902-4441

VL - 107

SP - 301

EP - 310

JO - European Journal of Haematology

JF - European Journal of Haematology

IS - 3

ER -

Intensive induction regimens after deferring initial therapy for mantle cell lymphoma are not associated with improved survival

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UN SDGs

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