Treatment patterns, health care resource utilization, and costs of chimeric antigen receptor T-cell vs standard therapy for relapsed/refractory mantle cell lymphoma in the United States.

Background: Standard of care (SOC) for relapsed/refractory mantle cell lymphoma (R/R MCL) has included chemoimmunotherapy and targeted therapies (eg, Bruton tyrosine kinase inhibitors [BTKis]). The approval of novel chimeric antigen receptor T-cell (CAR T) therapy in 2020 expanded therapeutic options.

Objective: To compare real-world patient characteristics, treatment patterns, health care resource utilization (HRU), and costs in traditional Medicare and commercially insured patients with R/R MCL treated with CAR T vs non-CAR T SOC (non-CAR T).

Methods: Adult patients with R/R MCL who had received 2 or more lines of therapy (LOTs) and continuously enrolled in their health plan between July 1, 2016, and December 31, 2021 (Medicare), or June 30, 2023 (commercial), were stratified into non-CAR T and CAR T cohorts based on therapy received during the study period after MCL diagnosis. Index date was 2L initiation for the non-CAR T cohort and CAR T infusion date for the CAR T cohort. Outcomes included time to next treatment (TTNT), treatment-free interval, MCL-related HRU (inpatient days, emergency department visits, and outpatient visits), and costs (medical and pharmacy).

Results: 2,835 non-CAR T and 122 CAR T patients were included. Compared with non-CAR T patients, CAR T patients were more often commercially insured (27% vs 17.3%; P < 0.01), younger (median age 69 vs 74; P < 0.0001), and male (75.4% vs 64.4%; P = 0.012). Median follow-up after index was 209.5 (CAR T) and 413 (non-CAR T) days. More than one-third (36.9%) of non-CAR T patients received 3L or higher LOT after index and median TTNT decreased with LOT from 689 days (2L) to 184 days (6L). In contrast, only 15% of CAR T patients required additional LOT, and median TTNT post-CAR T was not reached. Duration of treatment-free interval similarly declined with LOT for non-CAR T patients, and the CAR T interval was significantly longer than all non-CAR T LOT. Use of targeted therapies in non-CAR T increased sequentially by LOT (2L: 76%; 6L: 93.2%; BTKi 2L: 26.8%; BTKi 6L: 34.1%). Following CAR T, 9% of patients received targeted therapy, predominantly lenalidomide based. All MCL-related HRU and medical and pharmacy costs were lower post-CAR T than post-index non-CAR T.

Conclusions: Non-CAR T was associated with a greater use of post-index LOT, which also had shorter TTNT and treatment-free intervals. This suggests frequent and earlier progression as patients cycle through non-CAR T therapies. Standardized costs were higher in post-index non-CAR T vs post-CAR T episode periods. This suggests that earlier adoption of CAR T may reduce cycling through increasingly more expensive and less effective non-CAR T LOTs, potentially reducing HRU and financial burdens on patients with R/R MCL and the health system.