Treatment (tx) patterns and real-world outcomes among patients (pt) with mantle cell lymphoma (MCL) in the Flatiron database.

Abstract

152 Background: Despite the increasing number of tx options for MCL, data on novel agents and associated OS are scarce. We assessed the tx patterns and estimated OS by line of therapy (LOT) among pts with MCL in the United States (US). Methods: This retrospective observational study using the Flatiron Health database included pts aged ≥ 18 y at initial MCL diagnosis who received first-line (1L) systemic tx for MCL during the index period (01/01/2011–03/31/2022) on the date of 1L tx initiation. Pts who had < 1 mo of data after the index date, received clinical study drug during the study period, or had other primary cancer diagnoses or active primary malignancies were excluded. Time to next tx (TTNT) was calculated from LOT start date to next LOT start date. OS was estimated using Kaplan-Meier methodology. Results: Of 4846 pts diagnosed with MCL, 2072 met all eligibility criteria and were included in the final cohort. The median age was 69 y; pts were mostly male (71%), from the Southern US (43%), had commercial health plan insurance (47%), and had stage IV disease at diagnosis (64%). The median length of follow-up from index was 27.4 mo. The most common 1L tx was bendamustine + rituximab (29%) and ibrutinib was the most common second-line (2L) and third-line or later (3L+) tx (25.5% and 10.5%, respectively); only 17% received a stem cell transplant. Median TTNT and OS were similar across subgroups (Table). Median time to start of LOT, TTNT, and OS for subgroups of pts who (1) received ≥ 2 LOTs, including an alkylating agent, Bruton tyrosine kinase inhibitor, and CD20-targeting agent (TRANSCEND NHL 001, MCL cohort eligibility criteria; n = 508); (2) received second-line or later (2L+) tx (n = 859); and (3) received 3L+ tx (n = 363) are shown in the Table. Conclusions: Bendamustine + rituximab and ibrutinib were the most common tx in 1L and 2L/3L+, respectively, among pts receiving approved tx. For all pts/subgroups,median TTNT was longest for the 1L LOT; median OS was longest from 1L start date. Diminishing TTNT and OS in subsequent LOTs after 1L tx provide benchmarks for future tx.[Table: see text]