29 June 2018

Survival times for a highly aggressive type of blood cancer have nearly doubled over the last decade due to the introduction of new targeted drugs, a Yorkshire study has shown.

University of York and NHS clinicians followed the treatment of 335 people with mantle cell lymphoma (MCL) in hospitals across Yorkshire and Humberside between 2004 and 2015. Survival times for newly diagnosed patients increased from two years to three and a half years over the period. 

The research, which was funded by the blood cancer research charity Bloodwise, is published in the British Journal of Haematology.  

MCL is diagnosed in around 500 people each year in the UK. It is an aggressive lymphoma that often needs to be treated immediately. While younger patients are normally treated with intensive chemotherapy at first, followed by a stem cell transplant, older people who cannot tolerate aggressive treatment typically receive a milder form of chemotherapy.

The York and NHS researchers conducting the research confirmed that improvements in survival times followed the combination of initial chemotherapy treatment with rituximab, a drug that uses the patient’s immune system to attack cancer cells.

Unfortunately, almost all patients with MCL will relapse and require further treatment. Until recently, there were few treatment options available other than further intensive chemotherapy, which was often not very effective and frequently had severe side effects.

It was shown that the introduction of new treatments, including the chemotherapy drug bendamustine, as well as the targeted, non-chemotherapy drug ibrutinib, have significantly improved the survival of people who relapsed after previous chemotherapy.  Ibrutinib works by targeting and switching off a protein linked to the growth and movement of mantle cell lymphoma cancer cells. Bendamustine works by interfering with DNA in cancer cells, preventing them from multiplying.

The research was carried out by the Haematological Malignancy Research Network (HMRN), collaboration between clinicians at 14 hospitals across Yorkshire and Humberside and epidemiologists at the University of York.

Survival times increased from eight months in patients who relapsed in the years 2004-11 to 17 months in those who relapsed in 2012-15. The number of patients over 70 years old who survive for a year or more after relapse has nearly doubled since 2004 - suggesting that the introduction of new targeted drugs are benefitting older patients who are unable to undergo intensive treatment.

Professor Russell Patmore, from the Department of Health Sciences at the University of York, said: “While the outlook for people with mantle cell lymphoma is still relatively poor compared to other types of lymphoma, our study has shown that the introduction of new therapies has improved survival times. This study shows the importance of monitoring the impact of treatment changes to see if they are making a difference, especially in rarer forms of cancer where it is difficult to conduct large-scale clinical trials.”

Liz Burtally, Research Communications Manager at the blood cancer research charity Bloodwise, said: “Many decades of research have resulted in the development of an increasing number of targeted drugs for blood cancers. While the outlook for people with mantle cell lymphoma is still relatively poor, these new drugs can give precious months or years to people’s lives. This important study shows where new treatments and treatment combinations are working for patients and where improvements can be made.”

HMRN captures detailed data to clinical trial standards on the treatment, response and outcome of every blood cancer patient diagnosed across Yorkshire and Humberside. Because this area’s population has similar characteristics to the UK as a whole, it means research findings are applicable to patients across the country. All diagnoses are made and coded to the latest World Health Organization classifications by clinical specialists at the Haematological Malignancy Diagnostic Service at St James’s Hospital in Leeds. Bloodwise has funded the HMRN since its formation in 2004.

The paper is available to read online at https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.15170


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