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Death from mantle cell lymphoma limits sequential therapy, particularly after first relapse: Patterns of care and outcomes in a series from Australia and the United Kingdom

Minson, Adrian; Hamad, Nada; Di Ciaccio, Pietro; Talaulikar, Dipti; Ku, Matthew; Ratnasingam, Sumita; Cheah, Chan; Yannakou, Costas K.; Bishton, Mark; Ng, Zi Yun; Agrawal, Shivam; McQuillan, Andrew; Johnston, Anna; Choong, Emily; Wong, Kimberly; McQuillan, James; Beekman, Ashley; Hawkes, Eliza; Dickinson, Michael

Death from mantle cell lymphoma limits sequential therapy, particularly after first relapse: Patterns of care and outcomes in a series from Australia and the United Kingdom Thumbnail


Authors

Adrian Minson

Nada Hamad

Pietro Di Ciaccio

Dipti Talaulikar

Matthew Ku

Sumita Ratnasingam

Chan Cheah

Costas K. Yannakou

Mark Bishton

Zi Yun Ng

Shivam Agrawal

Andrew McQuillan

Anna Johnston

Emily Choong

Kimberly Wong

James McQuillan

Ashley Beekman

Eliza Hawkes

Michael Dickinson



Abstract

Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma characterised by a heterogeneous clinical course. Patients can often receive sequential treatments, yet these typically yield diminishing periods of disease control, raising questions about optimal therapy sequencing. Novel agents, such as chimeric antigen receptor T-cell therapies and bispecific antibodies, show promise in relapsed MCL, but are often reserved for later treatment lines, which may underserve patients with aggressive disease phenotypes who die early in the treatment journey. To assess the problem of patient attrition from lymphoma-related death limiting sequential treatment, we performed a multicentre retrospective cohort analysis of 389 patients treated at Australian and UK centres over a 10-year period. Deaths from MCL increased after each treatment line, with 7%, 23% and 26% of patients dying from uncontrolled MCL after first, second and third lines respectively. Patients with older age at diagnosis and early relapse after induction therapy were at particular risk of death after second-line treatment. This limitation of sequential treatment by lymphoma-related death provides support for the trial of novel therapies in earlier treatment lines, particularly in high-risk patient populations.

Journal Article Type Article
Acceptance Date Oct 19, 2023
Online Publication Date Oct 30, 2023
Publication Date 2024-02
Deposit Date Nov 10, 2023
Publicly Available Date Nov 10, 2023
Journal British Journal of Haematology
Print ISSN 0007-1048
Electronic ISSN 1365-2141
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 204
Issue 2
Pages 548-554
DOI https://doi.org/10.1111/bjh.19179
Keywords lymphoid malignancies, lymphomas, new drugs for lymphoma
Public URL https://nottingham-repository.worktribe.com/output/26811170
Publisher URL https://onlinelibrary.wiley.com/doi/10.1111/bjh.19179