Results from the study revealed that in the first-line setting, patients who received a BTK inhibitor underwent a mean of 1.9 outpatient visits per patient per month (PPPM) compared with 4.2 for bendamustine-based regimens, 5.7 for R-CHOP (rituximab [Rituxan], cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone), 3.4 for rituximab monotherapy, 5.0 for bortezomib-based regimens, 2.9 for venetoclax (Venclexta)–based regimens, and 6.0 for other regimens. These figures for inpatient services were 0.6, 1.5, 0.7, 1.0, 0.9, 1.5, and 2.3 mean visits PPPM, respectively. For other medical/hospital services the respective figures were 3.3, 4.1, 2.3, 1.3, 3.0, 1.4, and 3.5 visits PPPM.
The study authors noted that these data were similar in the second- and third-line and beyond settings; the mean PPPM for outpatient visits during treatment were lowest for BTK inhibitors across all lines of therapy compared with all other regimens. R-CHOP had the highest mean visits PPPM in the second and third line and beyond. Other chemotherapy regimens had the highest mean PPPM for inpatient services during first- and second-line treatment and bendamustine-based regimens were the highest in the third line and beyond. Bortezomib-based regimens had the highest mean PPPM for other medical/hospital services in the second and third lines and beyond. Notably, BTK inhibitors were the only approach to display 2 or less mean other medical/hospital services PPPM across all lines of therapy.
“This real-world study suggests that while patients with MCL generally received guideline-concordant treatment, unmet clinical needs remain, evidenced by relatively short time to next treatment [TTNT] and substantial HCRU,” Alvaro Alencar, MD, an associate professor of Clinical Medicine and the Chief Medical Director at the University of Miami Sylvester Comprehensive Cancer Center in Florida, and his coauthors wrote in a poster presentation of the findings. “BTK inhibitor regimens were associated with the lowest HCRU while chemotherapy-based regimens were with the highest HCRU.”
What Were the Methods and Baseline Characteristics of the Real-World Study?
The retrospective, observational real-world study used data from the Symphony Integrated Dataverse. It included adult patients who were diagnosed with MCL and initiated a first-, second-, or third-line treatment between January 2019 and September 2024.1 The date of the treatment regimen initiation was categorized as the index date; patients were required to be continuously enrolled in the database for 30 days before and after the index date.
The study authors examined treatment utilization patterns by treatment regimen, line of therapy, and year of index. TTNT was calculated based on the index date to the start of the next line of therapy among patients who progressed to a next line of treatment.
The objective of the study was to “examine the disease burden, treatment utilization patterns, and associated clinical and economic outcomes in real-world patients with MCL by year and line of therapy in the US.”
At baseline, most patients treated in the first- (n = 7503), second- (n = 4506), and third-line and beyond (n = 1383) settings were male (70.49% vs 71.73% vs 74.84%). Most patients treated in the respective settings were also at least 65 years of age (67.57% vs 74.15% vs 80.04%) and were White/non-Hispanic (62.84% vs 65.71% vs 68.69%).
What Were the Key Treatment Utilization and TTNT Data?
In the frontline setting, bendamustine-based regimens were the most used treatment approach (45%) across the study period, followed by rituximab monotherapy (21%) and BTK inhibitors (14%). In the second- and third-line and beyond settings, BTK regimens were the most utilized regimen, at 54.3% and 45.8%, respectively, followed by bendamustine-based regimens at 15.4% and 8.2%, respectively, and rituximab monotherapy at 10.3% and 12.4%, respectively.
Overall, the mean TTNT in the first, second, and third line and beyond was 16.3 months, 17.8 months, and 17.6 months, respectively. In the second line, the mean TTNT ranged from 8.2 months for venetoclax-based regimens to 20.9 months for rituximab monotherapy. In the third line, the mean TTNT ranged from 9.8 months for R-CHOP to 20.3 months for BTK inhibitors.
“Patients with MCL mostly received treatment that resulted in short TTNT and substantial HCRU, underscoring the unmet needs of patients with MCL and highlighting the need for novel agents to lower the disease burden in MCL,” the study authors wrote in their conclusion.
Disclosures: Alencar reported receiving funding from Incyte and Loxo Oncology/Lilly. He also received honoraria from Dr Reddy and advisory board fees from ADC Therapeutics, BeiGene, AbbVie, Lilly, Genentech, Amgen, and Incyte.
References
- Alencar A, Xue M, Chaung PY, Furnback W, Yang K. Real-world burden of disease (BoD), treatment patterns, and outcomes in patients with mantle cell lymphoma (MCL). Presented at: 2025 SOHO Annual Meeting; September 3-6, 2025; Houston, TX. Abstract MCL-1072.
- FDA approves acalabrutinib with bendamustine and rituximab for previously untreated mantle cell lymphoma. FDA. January 16, 2025. Accessed September 10, 2025. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-acalabrutinib-bendamustine-and-rituximab-previously-untreated-mantle-cell-lymphoma