“New treatments for mantle cell lymphoma (MCL) have improved survival and increased the life expectancy
of survivors,” says Ingrid Glimelius, MD, PhD. “However, due to patients with MCL living longer, late effects
have become a reality and a problem that needs to be investigated. We wanted to know what side effects to
look for, what treatments should be avoided, and how to tailor treatments to individual patients.”
For a study published in Blood Advances, Dr. Glimelius and colleagues examined the extent of late effects
among patients with MCL treated with or without high-dose chemotherapy with autologous stem cell transplantation
(HD-ASCT). The cohort included adult patients from the Swedish Lymphoma Register (N=620; treated with HD-ASCT, N=247).

Patients With MCL Have Higher Risk for Complications

“We gathered data on all diagnostic criteria and treatments and then linked this data to information on patients’
visits with a healthcare professional upon completion of their primary treatment (1 year of follow-up),” Dr.
Glimelius says. The study group compared the results to health-, age-, and sex-matched comparators to
determine which side effects/late effects to expect from aging and which ones were higher in patients due
to lymphoma and/or treatments. Dr. Glimelius and colleagues found that patients with MCL had higher
hospitalization rates, as well as a higher risk for hematologic, respiratory, and infectious complications
than healthy comparators, after completing the first year of primary treatment (Figure). “Late effects
were mainly caused by recurrent lymphoma, so it is of utmost importance to treat the underlying lymphoma,”
Dr. Glimelius says. “Unexpectedly, autologous stem cell transplant did not cause a higher disease burden
compared with no transplantation. We think this is because patients who did not have a transplant had more
relapses, were given more treatment, and thus had more complications. Therefore, the takeaway message was
to focus on treating the lymphoma.” She added that clinicians should not forget to look for secondary
complications in survivors of MCL, particularly blood disorders, infections, and secondary cancers.

Complications Are Mostly Due to Lymphoma, Not Treatment

“Physicians should not reduce treatment for the lymphoma to potentially reduce side effects,” Dr. Glimelius
says. “Today, most patients suffer from complications from their underlying MCL and not from the treatment.
The majority will also die from their lymphoma and not from a complication due to treatment.” Dr. Glimelius
and colleagues agree that more efficient primary treatments for patients with MCL are needed, both to improve
survival and to reduce the risk for relapses and thus side effects and late complications. More tolerable
treatments are also needed, she adds. “We would like to see large, randomized trials investigating different
treatment concepts in MCL, focusing on late effects,” Dr. Glimelius says. “In our study, we were surprised
to discover that there was not more toxicity and late effects in patients who had transplants versus
those who did not have transplants. From the perspective of late effects, it does not look as if the transplantation
is the source of the problem. Therefore, finding the source requires further investigation.”

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