Late effects in patients with mantle cell lymphoma treated with or without autologous stem cell transplantation

Abstract

Studies on late effects in mantle cell lymphoma (MCL) patients are increasingly important as survival is improving and novel targeted drugs are being introduced, however knowledge about late effects is limited. The aim of this population-based study was to describe the magnitude and panorama of late effects among patients treated with or without high-dose chemotherapy with autologous stem cell transplantation (HD-ASCT). The study cohort included all MCL patients, recorded in the Swedish Lymphoma Register, 18-69 years old, diagnosed 2000-2014 (total n=620, treated with HD-ASCT n=247) and 1:10 matched healthy comparators. Patients and comparators were followed via the national Patient Register and Cause-of-Death-Register, from 12 months after diagnosis/matching until December 2017. Incidence rate ratios of numbers of outpatient visits, hospitalizations and bed days were estimated using negative binomial regression models. In relation to the matched comparators, the rate of specialist and hospital visits was significantly higher among MCL patients (IRR 2.0, 95% CI: 1.8-2.2 and 7.2, 95% CI: 6.3-8.3, respectively). MCL patients had especially high relative risks of infectious, respiratory and blood disorders. Within this observation period, no difference in rate of these complications, including secondary neoplasms, was observed between HD-ASCT and non-HD-ASCT treated patients. The majority of patients died from their lymphoma and not from another cause or treatment complication. Taken together, our results imply that the vast majority of the post-treatment healthcare needs are related to the lymphoma disease itself, thus, indicating the need for more efficient treatment options.

Infections in patients with mantle cell lymphoma

“…Additionally, the incidence rate ratio (IRR) for inpatient bed days for infections was 1.49 (1.38−1.61), and this increase persisted for up to a 10‐year follow‐up period 16 . In another recent study that included a partially overlapping population, MCL patients exhibited higher rates of infection‐related outpatient visits and hospitalizations than comparators 1 . These findings align with the results obtained in our report, indicating a consistent pattern of increased infection‐related healthcare utilization in MCL patients but without details of specific infections and treatments as presented in our study.…”

“…Patients also have a cumulative immunosuppressive state due to the underlying lymphoma and, with that, an elevated risk of infections. We therefore hypothesized that infections are a significant cause of morbidity in MCL patients, 1 attributed to a complex interplay between the disease itself, antineoplastic treatments, age-related issues, and disease complications. [2][3][4][5] Patients with MCL exhibit immune deficiencies involving various immune system components, such as B, dendritic, T, and natural killer cells.…”