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Unmarried or less-educated patients with mantle cell lymphoma are less likely to undergo a transplant, leading to lower survival

Glimelius, Ingrid ; Smedby, Karin E. ; Albertsson-Lindblad, Alexandra LU ; Crowther, Michael J. ; Eloranta, Sandra ; Jerkeman, Mats LU and Weibull, Caroline E. (2021) In Blood Advances 5(6). p.1638-1647
Abstract

It is unknown how many mantle cell lymphoma (MCL) patients undergo consolidation with autologous hematopoietic cell transplantation (AHCT), and the reasons governing the decision, are also unknown. The prognostic impact of omitting AHCT is also understudied. We identified all MCL patients diagnosed from 2000 to 2014, aged 18 to 65 years, in the Swedish Lymphoma Register. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression models were used to compare the likelihood of AHCT within 18 months of diagnosis. All-cause mortality was compared between patients treated with/without AHCT using hazard ratios (HRs) and 95% CIs estimated from Cox regression models. Probabilities of being in each of the following states:... (More)

It is unknown how many mantle cell lymphoma (MCL) patients undergo consolidation with autologous hematopoietic cell transplantation (AHCT), and the reasons governing the decision, are also unknown. The prognostic impact of omitting AHCT is also understudied. We identified all MCL patients diagnosed from 2000 to 2014, aged 18 to 65 years, in the Swedish Lymphoma Register. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression models were used to compare the likelihood of AHCT within 18 months of diagnosis. All-cause mortality was compared between patients treated with/without AHCT using hazard ratios (HRs) and 95% CIs estimated from Cox regression models. Probabilities of being in each of the following states: alive without AHCT, alive with AHCT, dead before AHCT, and dead after AHCT, were estimated over time from an illness-death model. Among 369 patients, 148 (40%) were not treated with AHCT within 18 months. Compared with married patients, never married and divorced patients had lower likelihood of undergoing AHCT, as had patients with lower educational level, and comorbid patients. Receiving AHCT was associated with reduced all-cause mortality (HR 5 0.58, 95% CI: 0.40-0.85). Transplantation-related mortality was low (2%). MCL patients not receiving an AHCT had an increased mortality rate, and furthermore, an undue concern about performing an AHCT in certain societal groups was seen. Improvements in supportive functions potentially increasing the likelihood of tolerating an AHCT and introduction of more tolerable treatments for these groups are needed.

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organization
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type
Contribution to journal
publication status
published
subject
in
Blood Advances
volume
5
issue
6
pages
10 pages
publisher
American Society of Hematology
external identifiers
  • pmid:33710334
  • scopus:85103167942
ISSN
2473-9529
DOI
10.1182/bloodadvances.2020003645
language
English
LU publication?
yes
id
d04000ca-ff14-4e4d-b2c4-9454c2c3caf8
date added to LUP
2021-04-07 14:17:18
date last changed
2021-04-08 03:00:06
@article{d04000ca-ff14-4e4d-b2c4-9454c2c3caf8,
  abstract     = {<p>It is unknown how many mantle cell lymphoma (MCL) patients undergo consolidation with autologous hematopoietic cell transplantation (AHCT), and the reasons governing the decision, are also unknown. The prognostic impact of omitting AHCT is also understudied. We identified all MCL patients diagnosed from 2000 to 2014, aged 18 to 65 years, in the Swedish Lymphoma Register. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression models were used to compare the likelihood of AHCT within 18 months of diagnosis. All-cause mortality was compared between patients treated with/without AHCT using hazard ratios (HRs) and 95% CIs estimated from Cox regression models. Probabilities of being in each of the following states: alive without AHCT, alive with AHCT, dead before AHCT, and dead after AHCT, were estimated over time from an illness-death model. Among 369 patients, 148 (40%) were not treated with AHCT within 18 months. Compared with married patients, never married and divorced patients had lower likelihood of undergoing AHCT, as had patients with lower educational level, and comorbid patients. Receiving AHCT was associated with reduced all-cause mortality (HR 5 0.58, 95% CI: 0.40-0.85). Transplantation-related mortality was low (2%). MCL patients not receiving an AHCT had an increased mortality rate, and furthermore, an undue concern about performing an AHCT in certain societal groups was seen. Improvements in supportive functions potentially increasing the likelihood of tolerating an AHCT and introduction of more tolerable treatments for these groups are needed.</p>},
  author       = {Glimelius, Ingrid and Smedby, Karin E. and Albertsson-Lindblad, Alexandra and Crowther, Michael J. and Eloranta, Sandra and Jerkeman, Mats and Weibull, Caroline E.},
  issn         = {2473-9529},
  language     = {eng},
  number       = {6},
  pages        = {1638--1647},
  publisher    = {American Society of Hematology},
  series       = {Blood Advances},
  title        = {Unmarried or less-educated patients with mantle cell lymphoma are less likely to undergo a transplant, leading to lower survival},
  url          = {http://dx.doi.org/10.1182/bloodadvances.2020003645},
  doi          = {10.1182/bloodadvances.2020003645},
  volume       = {5},
  year         = {2021},
}