Real-World Data Shows Substantial Burden of Cost, AEs for Patients With MCL

Patients with mantle cell lymphoma (MCL) face a substantial economic burden and susceptibility to adverse events (AEs) in the real world, according to an abstract presented at the 61st American Society of Hematology Annual Meeting and Exposition.

While there has been data from controlled trials in academic centers on overall survival and AEs in patients with MCL, there has been more limited data on real-world management and outcomes for these patients. Researchers used a Medicare database to analyze 1465 patients with MCL who received any systemic cancer-directed treatment from 2013 to 2015. They were followed through 2016.

Among the patients included in the study, the median age was 74 years, 68% were male, 93% were white, and ibrutinib monotherapy was the most frequently used (n = 588, 40%). Bendamustine and rituximab (BR) combination was the second most common treatment (n = 527, 36%).

Half (52%) of patients on ibrutinib died during the median follow-up duration of 15 months compared with 28% of patients on BR who were followed up for a median duration of 21 months. Patients on ibrutinib had a higher Charlson Comorbidity Index score (4.0 vs 3.0).

The most common hematologic AEs were anemia, which was more common in patients taking ibrutinib (50.7% vs 45.7%); neutropenia, which was more common on BR (67.2% vs 17.0%); and thrombocytopenia, which was more common on ibrutinib (31.1% vs 21.6%).

Among all patients, the average per patient per month costs were $2501 during baseline, which increased substantially to $12,604 after initiation of MCL-directed systemic therapy. Patients with 3 or more AEs had monthly per patient costs that were nearly 4 times higher than patients with 2 or fewer AEs.

In the real-world setting, 2-year survival rates were 47% for patients taking ibrutinib and 73% for patients on BR, which was comparable to findings in clinical trials.

“Rates of AE occurrence in [ibrutinib]- and BR-treated patients in this study highlight the substantial burden and susceptibility to AEs among Medicare patients in the real-world setting,” the authors concluded. “These findings also demonstrate a substantial increase in the economic burden from the baseline period to the period after MCL treatment initiation and as the number of AEs increased.”

Reference

Kabadi SM, Goyal RK, Nagar SP, et al. Overall survival, adverse events, and economic burden in Medicare-insured patients with mantle cell lymphoma receiving cancer-directed therapy. Presented at: 61st American Society of Hematology Annual Meeting & Exposition, December 7-10, 2019; Orlando, Florida. Abstract #63.