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Mantle cell lymphoma: from audit to NHS drug approval

Why did we do this study?

Mantle cell lymphoma is a rare disease that is more common in men than women and tends to be diagnosed in people aged around 70 years old. Most (though not all) people with this disease need to have chemotherapy, and although there are guidelines stating what the first treatment should be, there is no specific advice about the chemotherapy that should be given next, if the disease progresses. Findings from previous clinical trials suggested that developments in the treatment of mantle cell lymphoma led to improvements in survival. As clinical trials tend to include younger and fitter patients, we wanted to know if these results were the same in the general population of patients (which includes those who are older and less fit) so we examined this within YHHN. 

What did we do?

We routinely collect disease-related information from the medical records of all patients diagnosed with mantle cell lymphoma, in each of the 14 hospitals in the YHHN area. Treatment data from patients diagnosed between 2004 and 2015 were analysed. We then monitored the same group until 2017, to check how they responded to treatment.

What did we find?

We found that treatment had changed significantly over time, as new chemotherapies were introduced. For example, although chlorambucil and FC (fludarabine and cyclophosphamide) chemotherapy (with or without rituximab) were commonly given in the past, more recently, a greater number of patients were treated with high dose cytarabine, bendamustine or ibrutinib. Importantly, an improvement was seen in the survival of patients treated more recently across YHHN's general population, suggesting that the use of newer agents improved outcomes for all people. Our findings from this audit were written up in a paper and published in a medical journal, which provides further, in-depth details of the study. Importantly, this work was then submitted to NICE (National Institute for Health and Care Excellence) as part of a process of getting approval for the routine use of ibrutinib for patients with relapsed disease in the NHS.