Certain Patients with Mantle Cell Lymphoma May Benefit from Delayed Treatment

Deferring treatment may actually be beneficial for some patients with mantle cell lymphoma (MCL), according to recent research.

A retrospective, multicenter analysis was conducted to evaluate how well delayed treatment worked for a total of 395 patients who had newly diagnosed mantle cell lymphoma between 1993 and 2015.

The 18 percent (72 patients) of patients who received deferred therapy — meaning that they did not start chemotherapy within three months of diagnosis – were more likely to have no systemic symptoms such as fever, night sweats and weight loss; an ECOG performance status of 0 (fully active, able to carry on all pre-disease performance without restriction); and normal LDH levels, which signify tissue damage.

“One of the challenges we have had with the management of this disease is that because it has historically behaved so aggressively, we feel everybody must get aggressive therapy upfront,” said Jonathon B. Cohen, M.D, an assistant professor in the department of hematology and medical oncology at Emory University School of Medicine.

“Then there are these patients with lower-grade disease clinically, and it just doesn’t make sense to treat them so aggressively,” he added, in an interview with OncLive, a sister publication of CURE.

These patients, Cohen explained, present with mantle cell lymphoma and have no symptoms or burden of disease. Their disease is contained in their bone marrow and blood, with the cancer having little to no spread into the lymph nodes.

“Interesting, we found that there was no significant impact on overall survival when we looked at those patients with deferred therapy versus those who received therapy immediately,” he said. “In fact, it appears that patients who had deferred therapy may live a little bit longer, although it is important to interpret that with caution.”

Traditionally, patients who were fit and young were often offered aggressive therapy, which included transplant. Those deemed to be not as fit were usually spared the transplant. But Cohen said that it is time to refine the way that physicians choose therapy for their patients.

“It is important to take into consideration the actual disease and how it is behaving in an individual patient, and to use that information to help guide decision-making,” he said. “It is not just about the fitness of the patient and their ability to tolerate therapy, but whether their disease and its clinical behavior requires treatment.”

Though he did admit that this may seem intimidating for the patient being told that his or her therapy will be pushed back.

“Certainly, it is unnerving for a patient who has recently been diagnosed with MCL to be told that they will be observed instead of start therapy,” Cohen said. “What I would tell a patient is that we still feel that they will require treatment, and when they do, we will be prepared to give them the best possible therapy.”

He also noted that many health care providers might be apprehensive to defer treatment for their patients. But he hopes that findings from studies like these — and others that have had similar outcomes – will encourage physicians to use this approach for the appropriate patients.

Once it is time for patients to start treatment, the next question is: Which kind? Additional analyses on the study are currently looking at whether or not intensive treatment is even needed for patients who had their treatment deferred.

“That is something that we are hoping to learn a little bit more about,” Cohen said. “That is an area that is very interesting to me, and we hope to hear about that later in 2018.”