Disease progression more than 6 years after treatment impacts overall survival in mantle cell lymphoma

Cancer research · Mantle cell lymphoma

Disease progression more than 6 years after treatment impacts overall survival in mantle cell lymphoma

Studies on mantle cell lymphoma (MCL) emphasize that patients with progression of disease (POD) before 24 months have inferior prognosis compared to patients with later POD. This population-based study assessed the impact of POD on overall survival (OS) by timing of progression and first-line treatment. A total of 1186 MCL patients diagnosed 2006–2018 were identified in the Swedish lymphoma register. POD was defined as progressive disease after first-line treatment or relapse following initial response. Hazard ratios (HRs) with 95% confidence intervals (CIs), comparing all-cause mortality among patients with and without POD, were estimated with Cox regression. An illness-death model was used to quantify the impact of timing of progression on OS, conditional on the timepoint of POD/PF (progression-free). Patients were followed for up to 10 years following treatment (median 3.7 years). BR, Nordic MCL2, and R‑CHOP/R‑CHOP‑like treatment were administered to 33%, 30%, and 14% of patients. Almost half (48%, n = 572) of patients experienced POD, with consequently higher mortality, regardless of timing and treatment (adjusted HR = 7.56, 95% CI: 6.32‑9.05). Importantly, even for patients with POD after 6‑10 years, mortality was more than twofold increased (HR = 2.67, 95% CI: 1.05‑6.79). On the absolute scale, a survival difference persisted for progression occurring up to 9 years after primary treatment. Especially early but also late progression (well beyond the 24‑month mark) has a large negative impact on survival in MCL. These results highlight the need for improved first‑line, including maintenance therapies to sustain remission and optimize outcomes for MCL patients.

The paper demonstrates that progression occurring several years after treatment still adversely affects overall survival, challenging the conventional 24‑month cut‑off as the primary prognostic time‑related marker in mantle cell lymphoma, and indicating a continuous need for maintenance therapies to prevent relapse.

Evidence level: Klinikai vizsgálat. Formális klinikai vizsgálati eredmény.

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