259O - Treatment patterns and outcomes in older patients with mantle cell lymphoma in an Asian population

Background

Significant progress have been made in the treatment outcomes of mantle cell lymphoma (MCL) since the introduction of cytarabine and rituximab in modern regimens. However, older patients may not readily tolerate these agents nor derive benefit. We investigated the impact of age on treatment patterns and clinical outcomes of MCL patients in an Asian population.

Methods

A retrospective study was conducted on patients (n=66) diagnosed with MCL at the National Cancer Centre Singapore between 1998 and 2018. The median follow-up duration was 40 months. Survival analyses were performed using the Kaplan-Meier method and multivariate Cox proportional models.

Results

The median age of the cohort was 59 years (range, 26-84), with a male predominance (73%). The majority (86%) had advanced stage 3-4 disease at diagnosis. Compared with younger patients, older patients aged ≥ 60 years (n=32; 48.5%) presented more frequently with B-symptoms (75% vs 38%, p=0.0028), anaemia (75% vs 35%, p=0.0013), and carried higher prognostic risk scores (sMIPI high risk 84% vs 56%, p=0.016). Non-cytarabine-based induction chemotherapy was more commonly administered in older patients (76% vs 32%, p=0.0012). The 5-year overall survival (OS) and progression-free survival (PFS) was 68% and 25% respectively. In a multivariable model, older age (HR 3.42, 95%CI 1.48-7.92, p=0.004) and anemia (HR 2.56, 95%CI 1.10-5.96, p=0.029) were independently associated with poorer OS while older age (HR 2.24, 95%CI 1.21-4.14, p=0.010) and hypoalbuminemia (HR 2.20, 95%CI 1.17-4.13, p=0.014) were independently associated with poorer PFS. In an exploratory analysis, maintenance rituximab following induction chemotherapy improved PFS in younger patients, with median PFS of 131 months and 45 months with and without maintenance therapy respectively (HR 0.39, 95%CI 0.16-0.93, p=0.0346). In contrast, no survival benefit was observed in older patients.

Conclusions

We demonstrated in an Asian cohort that older patients with MCL remain challenging to manage given their adverse clinical features and inability to derive benefit from contemporary treatment advances.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

National Medical Research Council of Singapore (TCR12DEC005) Tanoto Foundation Professorship in Medical Oncology New Century Foundation Limited Ling Foundation Singapore National Cancer Centre Research Fund SHF-Foundation SingHealth Duke-NUS Academic Medical Centre and Oncology ACP.

Disclosure

All authors have declared no conflicts of interest.