Treatment patterns and healthcare utilization for patients with relapsed or refractory (R/R) mantle cell lymphoma (MCL) in the Veterans Health Administration (MCLOVA) who were prescribed their first Bruton Tyrosine Kinase inhibitor (BTKi): A national retrospective cohort study

IntroductionMantle cell lymphoma (MCL) is a rare subtype (5%) of Non-Hodgkin Lymphoma (NHL), with 5-year survival of about 50%. Bruton Tyrosine Kinase inhibitors (BTKis) may improve health outcomes for patients with relapsed or refractory (R/R) MCL.Study objectiveThe objective of this study was to compare treatment patterns and healthcare utilization for patients with R/R MCL prescribed their first BTKi therapy using data from the national Veterans Health Administration (VHA).MethodsThis was a retrospective cohort study of adult patients (18 + years) prescribed BTKis for MCL in all VHA medical facilities in the United States from 1/1/20 to 12/31/23. Data were statistically analyzed using chi-square, Wilcoxon Rank-Sum test, Kaplan-Meier (KM) curves, multivariable negative binomial regression, and Cox Proportional Hazards regression, and a p-value <0.05.ResultsThere were 494 patients included. Of those included, 177 received ibrutinib, 189 received acalabrutinib, and 128 received zanubrutinib. More patients on ibrutinib switched to other BTKis (27%) compared to patients on acalabrutinib (10%, p < 0.01) or zanubrutinib (9%, p < 0.01). Median (interquartile range [IQR]) laboratory visits at 12 months were higher for ibrutinib (5, 0-12) than acalabrutinib (1, 0-8, p < 0.01) or zanubrutinib (0, 0-6, p < 0.01). Finally, overall survival (OS) was higher for patients on zanubrutinib than those on ibrutinib (p < 0.01) or acalabrutinib (p < 0.01).ConclusionsPatients prescribed acalabrutinib and zanubrutinib experienced fewer laboratory and hematology/oncology visits at 12 months than patients who received ibrutinib. Patients who received zanubrutinib experienced a survival advantage when compared to those treated with ibrutinib.