Incidence, Survival Trends, and Comparative Effectiveness of Novel Agents for Mantle Cell Lymphoma Patients in the U.S.

Shuangshuang Fu, The University of Texas School of Public Health


The study had three specific aims. 1) To determine the trends, variations and features in adult mantle cell lymphoma (MCL) incidence from 1995 to 2013 in Texas Cancer Registry (TCR) and Surveillance, Epidemiology, and End Results Program (SEER) Registries. 2) To assess the survival trend for adult patients diagnosed with MCL (aged 20-64 as well as 65 or older) over the past 19 years from 1995 to 2013 in Texas and SEER areas. 3) To evaluate the comparative effectiveness of common treatment regimens (chemotherapy-only, rituximab ± chemotherapy, bortezomib ± chemotherapy, bendamustine ± chemotherapy) for treating MCL in Medicare beneficiaries aged 65 or older in 1992-2013. In the first paper, 2,435 and 5,193 newly diagnosed adult MCL patients were included in Texas and SEER 13 Registries from 1995 to 2013. Age-adjusted MCL incidence was 0.91 per 100,000 persons per year in Texas and 1.01 in SEER areas. MCL incidence increased steadily with an annual percent change (APC) of 2.56% in SEER areas and an APC of 2.16% in Texas. In SEER areas, APCs for MCL incidence were statistically significant from zero in patients with advanced stage tumor (3.33%), male (2.71%), elderly patients ≥80 years old (4.21%) and non-Hispanic white patients (2.83%) (All P < 0.05). Similar patterns were found in Texas for both incidence rates and APCs. In the second paper, 7,555 and 2,055 patients were identified from SEER 18 Registries and TCR, respectively. Patients were grouped into four calendar periods 1995-1998, 1999-2004, 2005-2008, and 2009-2013. In SEER areas, unadjusted all-cause mortality rates decreased significantly from 1995 to 2013 (P= 0.0001). In multivariable cox proportional hazard regression analysis, the risk of MCL-specific death decreased significantly over the study period (P<0.0001). In stratified analysis by tumor stage, only patients with advanced tumor stage showed a significantly decreased risk of MCL-specific death (P<0.0001). Similar results were observed in TCR area. In the third paper, 1,215 eligible elderly MCL patients were identified from SEER-Medicare (chemotherapy alone=175, rituximab group=840, bortezomib=24, and bendamustine=176). Bortezomib group was not included in the primary analyses due to small sample size. In the multivariable cox proportional regression analyses, rituximab group showed significant decrease in both 1-year all-cause mortality (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.25-0.59) and MCL-specific mortality (HR: 0.38, 95% CI: 0.24-0.60) compared with chemotherapy alone group. Bendamustine group showed significant decrease only in 1-year MCL-specific mortality (HR: 0.49, 95% CI: 0.24-0.99) compared with chemotherapy alone group. There was no significant difference in the hazard of death between bendamustine and rituximab groups. We concluded that MCL incidence rates increased over time in both Texas and SEER areas, with increases being greater in male, non-Hispanic white, and elderly patient ≥70 years with advanced stage tumors. Texas has similar MCL incidence trends and disparities as the national SEER areas. The survival outcome for MCL patients improved in both SEER and TCR areas, especially for patients with advanced stage tumor, reflecting potential impact of administration of new regimens. For elderly patients newly diagnosed with MCL, addition of rituximab and bendamustine as first-line treatment showed significantly decreased 1-year mortality compared with chemotherapy alone group. Bendamustine-based regimen had similar effectiveness compared to rituximab-based regimen.

Subject Area

Biostatistics|Public health|Epidemiology

Recommended Citation

Fu, Shuangshuang, "Incidence, Survival Trends, and Comparative Effectiveness of Novel Agents for Mantle Cell Lymphoma Patients in the U.S." (2018). Texas Medical Center Dissertations (via ProQuest). AAI10830351.