Clinicopathologic characteristics and survival outcome of patients with mantle cell lymphoma: A North Indian tertiary care center experience

Abstract

Purpose: Mantle cell lymphoma (MCL) is a rare aggressive variant of non-Hodgkin lymphoma. Clinical and survival data from India are scarce. Materials and Methods: We retrospectively analyzed clinicopathologic data of 98 patients with MCL treated at our center in the past 10 years. STATA 13.0 was used for overall survival (OS) and event-free survival (EFS) assessment by Kaplan-Meier analysis. Univariate and multivariate analyses (Cox proportional hazards) were used to identify predictors of survival. P value < .05 defined statistical significance. Results: Median age was 60.0 years. There was extranodal involvement in 77/98 (79.0%) patients. Ninety-one of 98 (93.0%) and 54/97 (56.0%) patients, respectively, were in advanced stage (III/IV) and high-risk MCL International Prognostic Index score at presentation. There was bulky disease in 19/98 (19.0%) patients. Classical histology and interstitial/paratrabecular bone marrow (BM) infiltration was most frequent. Sixteen percent had BM without peripheral blood involvement. Most patients, 83/96 (86.0%), received rituximab-based induction chemotherapy. Fifty-one of 96 (53.0%) patients were alive with a median follow-up of 63.0 months. Median OS was 43.0 months. Estimated 3.0-year OS and EFS were 60.0% and 35.0%, respectively. Rituximab maintenance (RM) improved both OS (P < .01) and EFS (P < .01). Median OS was lower in the non-RM group (37.0 months v not reached; adjusted hazard ratio, 0.31 [95% CI, 0.13 to 0.72], P < .01). Age >60 years, Eastern Cooperative Oncology Group performance status ≥2, advanced stage, and leukocytosis at presentation were associated with poor OS. Conclusion: Our study was a comprehensive analysis of patients with MCL from India. To our knowledge, this was the first study of its kind demonstrating OS and EFS benefit of RM in MCL from this part of the world.