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Real-World Practice Patterns, Comorbidities in Medicare Patients With MCL

January 22, 2021

Older patients with mantle cell lymphoma (MCL) have a high rate of comorbidities impacting treatment choices and overall survival (OS), according to a real-world analysis published in the Journal of Geriatric Oncology (2021;S1879-4068[20]30535-X. doi:10.1016/j.jgo.2020.12.013).

“Although treatment approaches to younger fit patients with mantle cell lymphoma (MCL) are well-described, the optimal treatment of older or less fit patients with varying comorbidities is less clear,” wrote Jessalyn A Weaver, MD, Department of Medicine, Hennepin County Medical Center (Minneapolis, MN), and colleagues.

This study aimed to assess first-line treatment patterns for Medicare patients with MCL and evaluate the impact of comorbidities and age on treatment choices and OS.

Medicare data were used to identify patients diagnosed with MCL from January 1, 2007 and August 31, 2015. Dr Weaver and colleagues collected and analyzed data on patient age, gender, race, Charlson comorbidities, Charlson comorbidity index (CCI), timing of injectable MCL therapies, and OS.

A total of 3008 patients were identified (median age, 75.5 years). Of these patients, >50% had ≥2 comorbidities. CCI was 1-2 for 45% of patients and 3-4 for 26.6% of patients.

The most common first-line therapy was rituximab (40.2%), regardless of patient age or comorbidity. Administration of cyclophosphamide, doxorubicin, vincristine, or bendamustine in the first-line setting was less common with 17.9%, 13.1%, 17.2%, and 12% of patients receiving each therapy, respectively.

Median OS among these patients was 3.23 years. OS decreased with increasing number of comorbidities.

“Our analysis of a real-world patient population with MCL found that older patients have a high rate of comorbidities which impact administered treatment and subsequent OS,” Dr Weaver and colleagues concluded.

“Our findings can be used to prospectively guide treatment decisions in these older, frailer, non-transplant-eligible patients, considering the impact of age and comorbidities on such choices,” they added.—Janelle Bradley

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