Unmarried, Low Education Tied To Lower Odds of Transplantation in Mantle Cell Lymphoma

Patients with mantle cell lymphoma who are unmarried, have a lower educational level, or with multiple comorbidities are less likely to undergo autologous hematopoietic cell transplantation (AHCT), according to a study.

“We don’t know exactly why the unmarried or less educated patients got transplants less often, but we can speculate that less social support, or inadequate information, may lead to a fear—in both the patient and doctor alike—of undergoing a very demanding treatment. If you have lots of other diseases, you can’t tolerate a transplant,” said lead study author Ingrid Glimelius, MD, PhD, chief physician and researcher at the Department of Immunology, Genetics and Pathology at Uppsala University, in a press release.

Dr. Glimelius and colleagues collected data from the Swedish Lymphoma Register on patients aged 18 to 65 years diagnosed with mantle cell lymphoma between 2000 and 2014. They assessed the odds of receiving AHCT within 18 months of diagnosis. They used an illness-death model to estimate the likelihood of being alive with and without AHCT, and dead before and after AHCT.

Of 369 patients identified, 148 did not receive AHCT within 18 months of diagnosis. Patients who were unmarried (never married or divorced), compared to married patients, were less likely to undergo transplantation. Patients with lower educational levels and comorbid patients also had a lower likelihood of AHCT. Patients in the youngest two age groups (age ≤49 years and 50-59 years) were more likely than older patients to undergo AHCT. Patients who did receive transplantation had lower all-cause mortality (hazard ratio, 0.58; 95% confidence interval, 0.40-0.85), and transplantation-related mortality was only 2%. The rate of mortality was higher among patients who did not undergo transplantation.

Not all patients are candidates for transplantation, Dr. Glimelius explained. For instance, patients who are either not very sick or are too sick to undergo the surgery may not be recommended for transplantation.

“But this study shows that the people who weren’t selected for a transplant also had clearly lower survival. This suggests that transplantation is a very important component in the treatment,” she said.

The study was published in Blood Advances.

“Studies of this kind are important because they can lead to certain groups in society being offered more support. They can also act as an eye-opener for patients, health professionals and politicians alike, showing that there’s still a need for more equality in health care in Sweden,” said Dr. Glimelius.

Dr. Glimelius and colleagues wrote in their conclusion, “A surprisingly high proportion of younger (<65 years) mantle cell lymphoma patients (40%) were not treated with AHCT as part of their primary treatment. Factors associated with a lower likelihood of being selected to an AHCT included higher age, being never married or divorced, having any comorbidity, and lower socioeconomic status.”