MCL-063 clinical characteristics and survival outcomes of patients with mantle cell lymphoma—a North Indian Tertiary care center experience

Abstract

Context: Mantle cell lymphoma (MCL) is an aggressive variant of non-Hodgkin lymphoma. Indian data is scarce owing to its rarity in Southeast Asia. Objective: Assess if rituximab maintenance (RM) improves overall survival (OS) of MCL patients. Study Design: We analyzed ambispective clinical data of 90 transplant-ineligible MCL patients treated between January 2013 and December 2023 at IRCH-AIIMS, New Delhi, India. Rituximab-based induction was used in all patients as per institutional protocol. Due to financial constraints, RM was used in 28 patients (31.0%). Primary outcome was OS. Secondary outcome was event-free survival (EFS). Response was assessed by modified Cheson's lymphoma response evaluation criteria. STATA 13.0 was used to assess survival by Kaplan-Meier analysis and log-rank test. Effect of RM on OS and EFS was adjusted for other factors in multivariate analysis by Cox proportional hazards model, then expressed as adjusted hazard ratio (aHR), 95% CI. P value <.05 defined statistical significance. Results: Median age 60 years; male-female ratio 3:1. Seventy-nine (88.0%) had generalized lymphadenopathy, 72 (80.0%) extra-nodal involvement, 49 (54.0%) B symptoms, 34 (38.0%) ECOG PS ≥2, 84 (93.0%) advanced stage (III/IV), 49 (54.0%) high-risk MIPI at presentation. Clinical and tumor characteristics and response rates after initial induction were similar in both RM and non-RM groups. Overall, 52 (58.0%) patients were alive with median follow-up of 63.0 months. Median OS was 37.5 months in the non-RM group and not reached in the RM group. In RM vs non-RM groups, the estimated 1-, 2-, and 3-year OS were 100.0%, 91.0%, and 81.0% vs 75.0%, 63.0%, and 55.0%, respectively. RM was significantly associated with better OS (aHR [95%CI]: 0.31 [0.13-0.75], P=.01). ECOG PS ≥2 was associated with poor OS (aHR [95%CI]: 2.41 [1.14-5.08], P=.02). Median EFS was significantly lower in non-RM group (14.0 vs 42.5 months; aHR [95%CI]: 0.34 [0.18-0.64], P=.001). Conclusions: This was the first study from Southeast Asia to demonstrate the impact of RM in MCL. RM significantly improved the OS and EFS of MCL patients. However, randomized controlled trials are needed to concretize the evidence of OS benefit.