Less aggressive therapy reasonable in primary GI mantle cell lymphoma

Primary gastrointestinal (GI) mantle cell lymphoma (MCL) is a rare disease with distinct presentations as compared to secondary GI MCL, a recent study has found. Patients with the primary malignancy tend to receive less aggressive treatment, but nevertheless achieve comparable clinical outcomes.

However, while the use of milder treatment is reasonable, it still remains to be seen if a more intensive, systematic approach can yield better outcomes.

Twenty-two patients with primary GI MCL participated in the study. Clinical characteristics of malignancy were compared against 79 patients with secondary MCL. No statistical between-group differences in clinicopathological characteristics were reported, particularly in terms of patient age and sex, and Eastern Cooperative Oncology Group (ECOG) performance status.

In terms of treatment, a significantly higher proportion of primary vs secondary GI MCL patients were initially observed or given localized therapy (28.6 percent vs 7.6 percent; p<0.01). In contrast, secondary GI MCL patients were more likely to receive autologous stem cell transplant as part of a frontline regimen (35.4 percent vs 13.6 percent; p<0.05).

Despite less aggressive treatment, outcomes were comparable between primary and secondary GI MCL patients. Five-year progression-free survival (PFS) rates, for example, were 30.0 percent and 28.1 percent, respectively (p=0.59), while the corresponding overall survival (OS) estimates at the same time point were 65.3 percent and 65.8 percent (p=0.83).

Cox regression analyses further validated that patients with primary and secondary GI MCL had comparable rates of PFS and OS.

“A better understanding of the molecular biology is needed, and the incorporation of novel therapeutic agents should be explored for patients with primary GI MCL,” the researchers said.