Treatment Advances Have Improved Outcomes for Patients with Relapsed/Refractory MCL

By Leah Sherwood - Last Updated: December 14, 2022

Advances in treatment have led to improved outcomes in patients with relapsed or refractory (R/R) mantle cell lymphoma (MCL), according to the results of a study investigating the treatment patterns and survival outcomes for patients with R/R MCL treated with second-line therapy.

The results, which were presented by Reema K. Tawfiq, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues at the 2022 American Society of Hematology Annual Meeting, were based on data from the Mayo Clinic/University of Iowa Molecular Epidemiology Resource (MER), a cohort study of nearly 7,000 patients newly diagnosed with lymphoma at the Mayo Clinic and the University of Iowa.

A total of 343 participants were prospectively followed for disease relapse/progression, subsequent treatments, and death. Patients who initiated second-line therapy for R/R MCL through 2021 were included in the analysis. Clinical characteristics, as well as first- and second-line therapies were extracted from MER and medical records.

Three eras were defined based on the timing of second-line treatment (see TABLE 1). Eras were chosen to align with approval of novel therapies, including bendamustine and rituximab (associated with Era 2) and Bruton’s tyrosine kinase (BTK) inhibitors (associated with Era 3).

TABLE 1. Outcomes for Patients Receiving Second-Line Treatment in Different Eras
Era 1


Era 2


Era 3


Median follow-up (years) 13.3 8.7 4.2
Overall response rate to second-line therapy 57% 79% 83%
Complete response rate to second-line therapy 30% 52% 51%
Two-year event-free survival (EFS) rate 21% 39% 58%
Five-year EFS rate 31% 38% 69%


“The changes in second-line treatment correlated with improved event-free and overall survival, suggesting that treatment advances were associated with improved outcomes in patients with R/R MCL,” the investigators observed.

The notable changes in second-line treatment patterns observed among different eras are likely due to drug availability and first-line treatment choices, according to the investigators. For example, few to no patients received a BTK inhibitor in second-line treatment in Eras 1 and 2, largely due to lack of availability, compared to 44% of patients in Era 3. The use of bendamustine and rituximab in the second-line was minimal in Era 1 (N=2; 3%) and less in Era 3 (N=8; 17%) compared to Era 2 (N=26; 37%).

However, the percentage of patients who received autologous or allogeneic hematopoietic stem cell transplant appeared similar across eras:

  • Era 1 (n=5; 9%)
  • Era 2 (n=10; 14%)
  • Era 3 (n=6; 13%).

“Larger real-world studies are needed to further understand treatment patterns, changes with time, and the association with outcomes in R/R MCL, including second-line and subsequent lines of therapy,” the investigators cautioned.


Tawfiq R, Lawson M, Gile J, et al. Treatment patterns and outcomes in relapsed/refractory mantle cell lymphoma. Abstract #2889. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.

Post Tags:Lymphoma ASH 22
Editorial Board