The objective of this real–world study was to describe baseline characteristics and compare treatment outcomes among patients with relapsed or refractory mantle cell lymphoma (R/R MCL) who received zanubrutinib or acalabrutinib as second–line or later therapy in routine clinical practice.
This was a retrospective, observational study conducted using the Integra Connect PrecisionQ de–identified real–world database. Adult patients with R/R MCL who initiated second–line or later zanubrutinib or acalabrutinib between January 1, 2018, and July 31, 2025, were included and followed through October 31, 2025. Outcomes included time to treatment discontinuation, time to next treatment, and overall survival. The probabilities of not discontinuing treatment, not advancing to next line of therapy from zanubrutinib or acalabrutinib initiation, and overall survival were estimated using the Kaplan–Meier method.
Overall, 93 patients received zanubrutinib and 91 received acalabrutinib. Median age was 68 years. Most patients were male (76.1%), non–Hispanic (77.2%), and White (84.2%). Median follow–up was 17.3 months (range, 3.0–53.3) for zanubrutinib and 20.2 months (range, 0.9–89.0) for acalabrutinib.
Median time to treatment discontinuation was longer with zanubrutinib than acalabrutinib (17.8 months [95% CI, 14.7–NR] vs 9.6 months [95% CI, 6.5–15.4]; log–rank P<0.01). The most common reasons for treatment discontinuation were toxicity (11.8% vs 11.0%), disease progression (6.5% vs 5.5%), and death (2.2% vs 4.4%) for zanubrutinib and acalabrutinib, respectively. Median time to next treatment was 18.2 months (95% CI, 15.4–not reached [NR]) with zanubrutinib and 15.4 months (95% CI, 9.6–26.6) with acalabrutinib (log–rank P=0.15). Median overall survival was not reached with zanubrutinib (95% CI, 30.0–NR) and was 51.5 months (95% CI, 41.7–NR) with acalabrutinib (log–rank P=0.37). Patients on zanubrutinib had a higher probability of not discontinuing treatment, not advancing to next line of therapy, and survival at 6, 12, and 18 months than those on acalabrutinib.
