Early Relapse Identifies MCL patients with Inferior Survival after Intensive or Less Intensive Frontline Therapy.

Overview

While an expanding array of effective treatments has resulted in recent improvement in survival for patients with mantle cell lymphoma (MCL), outcomes remain heterogeneous and identification of prognostic factors remains a priority. We assessed the prognostic impact of time to progression of disease (POD) after first-line therapy among 455 patients with relapsed MCL. Patients were categorized by duration of first remission as PRF/POD6, defined as progressive disease during induction or POD within six months of diagnosis (n=65, 14%), POD6-24, defined as POD between six and 24 months from diagnosis (n=153, 34%), and POD>24 defined as POD beyond 24 months from diagnosis (n=237, 53%). Median overall survival from POD (OS2) was 1.3 [95% CI 0.9-2.4] years for PRF/POD6 patients, 3 [95% CI 2-6.8] years for POD6-24, and 8 [95% CI 6.2-NR] years among POD>24 patients. Median OS2 was inferior in patients with early POD (defined as PRF/POD6 or POD6-24) following both intensive and less intensive frontline treatment. The prognostic performance of time to POD was replicated in an independent cohort of 245 patients with relapsed MCL, with median OS2 of 0.3 [95% CI 0.1-0.5] years for PRF/POD6, 0.8 [95% CI 0.6-0.9] years for POD6-24, and 2.4 [95% CI 2.1-2.7] years for POD>24. Early POD is associated with inferior OS2 in patients with relapsed MCL, identifying a high-risk population for future prospective studies.