Despite an association with improved overall survival for mantle cell lymphoma (MCL), upfront autologous stem cell transplantation (ASCT) is only used in a minority of patients. Socioeconomic factors and access to specialized care both predicted ASCT use, according to a recent study.
Looking at data from the National Cancer Database, researchers identified 10,290 patients with newly diagnosed MCL treated with chemotherapy with or without upfront ASCT. Only 1,774 (17.2%) of patients received multiagent chemotherapy followed by consolidative ASCT.
People more likely to undergo ASCT were younger and more likely to have lower comorbidity scores, private insurance, higher income and education, and treatment at an academic facility.
The study did reveal that the use of ASCT increased over time from 11.9% in 2004 to 21.2% in 2012 (P<0.001). This increase was seen in younger and older patients.
A multivariable analysis showed that age, comorbidity index, insurance type, the transition of care, facility type, distance to facility, and diagnosis year were all predictive for ASCT use.
Treatment with ASCT was associated with improved 5-year overall survival for younger (82% vs. 64%; P < 0.001) and older (70% vs. 40%; P<.001) patients.
“With a 5-year OS rate of 82%, our real-world data confirm the improved outcomes reported in clinical trials of young MCL patients undergoing frontline consolidative ASCT,” the researchers wrote. “For older patients, who are typically excluded from clinical trials, the 5-year OS rate of 70% with ASCT suggests that frontline consolidative ASCT may yield favorable outcomes in a select subset of older MCL patients.”
Female gender, the diagnosis year of 2009 or later, private insurance, higher income, and education were all associated with superior survival. In contrast, Black race and higher comorbidities predicted inferior survival.
“These results should be interpreted with caution, as we were unable to evaluate the impact of disease characteristics, type of induction chemotherapy, and response to chemotherapy that can frequently influence treatment decisions,” the researchers wrote.