Clinical Scorecard: Survival Gains Across Treatment Eras in Mantle Cell Lymphoma: Age-Stratified Outcomes
At a Glance
Category
Detail
Condition
Mantle cell lymphoma (MCL), an aggressive B-cell non-Hodgkin lymphoma subtype.
Key Mechanisms
Treatment eras were defined by calendar period and characterized by rituximab integration; intensified immunochemotherapy, including bendamustine-rituximab, and ASCT consolidation; first-generation BTK inhibitor use; and expanded targeted therapy and CAR-T. Individual treatment exposure was not reported.
Target Population
Adults aged 18 years or older with a first primary, pathologically confirmed MCL diagnosis in the SEER-17 database from 2000 through 2023.
Care Setting
Population-based US cancer registry analysis of MCL-specific mortality, relative survival, overall survival, and competing causes of death across treatment eras and age groups.
Key Highlights
Among 12,785 patients, 3-year MCL-specific mortality declined from 34.2% in 2000–2006 to 22.8% in 2020–2023.
Three-year relative survival increased from 63.8% in era 1 to 73.6% in era 4.
MCL-specific mortality declined across all four age categories; among patients aged 85 years or older, 3-year cumulative incidence declined from 60.6% in era 1 to 52.1% in era 4.
The age-by-era interaction was significant (P = 0.009), indicating that the association between era and outcome varied by age group.
Three-year cumulative incidence of death from other causes rose from 7.5% in era 1 to 8.9% in era 4.
Guideline-Based Recommendations
Diagnosis
Study eligibility required adults with a first primary, pathologically confirmed MCL diagnosis (ICD-O-3 code 9673/3); primary CNS involvement and unavailable survival data were excluded.
Management
The study grouped patients by calendar-era treatment context and did not report individual treatment exposure or provide treatment recommendations.
The authors note that ASCT was used for selected patients and that randomized studies have questioned its continued necessity in selected patients.
Monitoring & Follow-up
The study assessed relative survival, MCL-specific survival, overall survival, and competing risks of MCL-specific and other-cause death.
Age-stratified analyses used categories of 65 years or younger, 66–74, 75–84, and 85 years or older.
Risks
Across eras, MCL-specific mortality was higher among patients older than 65 years than among those 65 years or younger (3-year CIF 35.4% vs 19.7%).
Patients aged 85 years or older had the highest MCL-specific mortality; their 3-year cumulative incidence declined from 60.6% in era 1 to 52.1% in era 4.
The 3-year cumulative incidence of death from other causes increased from 7.5% in era 1 to 8.9% in era 4.
Patient & Prescribing Data
The cohort included 12,785 adults with MCL; mean age at diagnosis was 67.2 years, 71.1% were male, and 56.0% were older than 65 years.
The registry analysis grouped patients by calendar-era treatment context and did not report individual prescriptions or treatment exposure. Era 4 (2020–2023) encompassed expanded targeted therapy and CAR-T, including zanubrutinib and brexucabtagene autoleucel.
Clinical Best Practices
The study compared outcomes by diagnosis era, not by individual treatment received.
The analysis estimated MCL-specific and other-cause mortality using competing-risks methods.
