Pre-treatment HRQOL Prognostic Factors Identified for Older Patients With Newly Diagnosed Mantle Cell Lymphoma

Researchers utilized the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire to examine the prognostic impact on survival of pre-treatment health-related quality of life parameters for patients with newly diagnosed mantle cell lymphoma.

Pre‐treatment health-related quality of life (HRQOL) parameters were comparable to age and gender matched reference populations, for patients with newly diagnosed mantle cell lymphoma (MCL) who were either over 65 years of age or ineligible for allogenic stem cell transplant, according to results from the phase 1b/2 NLG‐MCL4 study (NCT00963534) published in Hematological Oncology.

Several functional scores among patients who completed questionnaires deteriorated during the first 6 months of treatment. Although changes in role functioning, and emotional and cognitive function were clinically significant, physical function changes were only statistically significant (P <.05). Pre‐treatment physical and role function were both found to be independent prognostic factors of survival in this patient population.

“Pre‐treatment HRQOL was comparable to an age and gender matched reference population, which may sound surprising, as the patients all were diagnosed with an uncurable hematological malignancy,” the investigators wrote. “One possible explanation is response shift, that is a change in the meaning of one's self‐evaluation due to a change in the internal standards of measurement.”

Patients included in the cohort underwent treatment with lenalidomide (Revlimid) plus rituximab (Rituxan) and bendamustine (Bendeka) for 6 months, which was then followed by 6 months of lenalidomide maintenance therapy.

Researchers analyzed HRQOL at baseline, 6 months, 12 months, and 24 months via the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30). The questionnaire includes 5 functional scales, 9 single symptom scales, and global health status. In terms of functional scales, areas included physical, emotional, cognitive, social, and role functioning. Areas of focus for symptom scale were fatigue, pain, nausea/vomiting, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties.

Once scores were collected, they were compared with scores of healthy individuals at baseline in age‐ and sex‐matched reference populations.

A total of 51 patients with previously untreated MCL were enrolled onto the trial from October 12, 2009, and May 22, 2013, 3 of whom were excluded from the final cohort. The median age of the cohort was 71 years (range, 62-84) and 73% were male. Fifty-two percent of patients were considered high-risk, 38% were intermediate-risk, and 10% were low-risk, according to the MCL International Prognostic Index. The study’s median follow-up time was 52 months for patients who were alive.

The proportion of patients who reported HRQOL at baseline was 96%, with 83%, 89%, and 75% reporting HRQOL after 6 months, 12 months, and 24 months, respectively. Twelve patients completed all 4 questionnaires, and there were a total of 117 questionnaires available for analysis. Of those 12 patients, 83% were male, median age was 73 years (range, 62-80), and 58% completed treatment.

During induction treatment, social function and global quality of life remained stable and improved 12 months after starting treatment. After increasing above baseline after 12 months, global quality of life score levels reverted to baseline after 24 months.

Cognitive function was the only functional scale in which the score after 24 months was lower compared with baseline scores, although that score was not different from the cognitive function score of the reference population.

An association was observed between improvements in overall survival (OS) and higher baseline levels of role function, social function, and pain because of the prognostic impact of different HRQOL scale scores.Additionally, an association was noted between improved progression-free survival and increased baseline scores of role function and overall quality of life.

“These findings may be used to design support during treatment and improve rehabilitation. Further investigations are needed for assessment of long‐term HRQOL,” the investigators concluded.


Lindberg Å, Eskelund CW, Albertsson-Lindblad A, et al. Pre-treatment health-related quality of life parameters have prognostic impact in patients >65 years with newly diagnosed mantle cell lymphoma: the Nordic Lymphoma Group MCL4 (LENA-BERIT) experience. Hematol Oncol. Published online October 28, 2021. doi:10.1002/hon.2940