Intensive treatment strategies may not provide superior outcomes in mantle cell lymphoma: overall survival exceeding 7 years with standard therapies.
BACKGROUND
Reported median overall survival (OS) in patients with mantle cell lymphoma (MCL) has been reported to be just 3-4 years. As a consequence, first-line treatment has become more aggressive. Single-center studies with R-Hyper-CVAD and/or autologous stem-cell transplant (ASCT) have produced 3-year OS rates >80%, prompting many to adopt their use. We evaluated outcomes from a single-center cohort managed in a more traditional fashion.


METHODS
We identified patients with MCL evaluated at Weill Cornell Medical Center since 1997, and included those with known date of diagnosis. An online social security database was used to verify survival.


RESULTS
We identified 181 patients with MCL, and date of diagnosis could be determined in 111. Three-year OS from diagnosis was 86% [95% confidence interval (CI) 78% to 92%]. Median OS was 7.1 years (95% CI 63-98 months). Adequate information on therapy was available for 75 patients. Only five were treated upfront with (R)-Hyper-CVAD or ASCT while an additional four patients received one of these regimens subsequently. Treatment type had no significant effect on OS.


CONCLUSIONS
Outcomes with standard approaches can yield similar survival to that achieved with more intensive approaches. Biases may account for the perceived superiority of aggressive strategies.
Martin
P
P
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Chadburn
A
A
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College.
Christos
P
P
Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College and New York Presbyterian Hospital, New York, USA.
Furman
R
R
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Ruan
J
J
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Joyce
M A
MA
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Fusco
E
E
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Glynn
P
P
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Elstrom
R
R
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Niesvizky
R
R
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Feldman
E J
EJ
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Shore
T B
TB
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Schuster
M W
MW
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Ely
S
S
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College.
Knowles
D M
DM
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College.
Chen-Kiang
S
S
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College.
Coleman
M
M
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital.
Leonard
J P
JP
Center for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College and New York Presbyterian Hospital. Electronic address: jpleonar@med.cornell.edu.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D014408:Biomarkers, Tumor / Q000032:analysis*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D016208:Databases, Factual; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011878:Radiotherapy; D012044:Regression Analysis; D012189:Retrospective Studies; D000069283:Rituximab; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D000069283:Rituximab; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone