title: Outcome of deferred initial therapy in mantle-cell lymphoma.
abstract: OBJECTIVE
  Treatment of mantle-cell lymphoma (MCL) is nonstandardized, though patients are commonly treated immediately at diagnosis. Because data on observation, or "watch and wait," have not been previously reported, we analyzed the outcome of deferred initial therapy.
  
  
  METHODS
  Inclusion criteria in this retrospective analysis were a diagnosis of MCL between 1997 and 2007 and known date of first treatment. Hospital and research charts were reviewed for prognostic and treatment-related information. Date of death was derived from hospital records and confirmed using an online Social Security death index.
  
  
  RESULTS
  Of 97 patients with MCL evaluated at Weill Cornell Medical Center, 31 patients (32%) were observed for more than 3 months before initial systemic therapy, with median time to treatment for the observation group of 12 months (range, 4 to 128 months). The observation group (median follow-up, 55 months) had a median age of 58 years (range, 40 to 81 years). Prognostic factors in assessable patients included advanced stage (III/IV) in 75%, elevated lactate dehydrogenase in 25%, and intermediate- or high-risk Mantle Cell International Prognostic Index in 54%. Better performance status and lower-risk standard International Prognostic Index scores were more commonly present in those undergoing observation. Although time to treatment did not predict overall survival in a multivariate analysis, the survival profile of the observation group was statistically superior to that of the early treatment group (not reached v 64 months, P = .004).
  
  
  CONCLUSIONS
  In selected asymptomatic patients with MCL, deferred initial treatment ("watch and wait") is an acceptable management approach.
authors.affiliation: Starr Building Rm 340, Weill Cornell Medical College and New York Presbyterian Hospital, 520 E 70th St, New York, NY 10021, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Martin
authors.forename: Amy
authors.initials: A
authors.lastname: Chadburn
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.forename: Karen
authors.initials: K
authors.lastname: Weil
authors.forename: Richard R
authors.initials: RR
authors.lastname: Furman
authors.forename: Jia
authors.initials: J
authors.lastname: Ruan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Elstrom
authors.forename: Ruben
authors.initials: R
authors.lastname: Niesvizky
authors.forename: Scott
authors.initials: S
authors.lastname: Ely
authors.forename: Maurizio
authors.initials: M
authors.lastname: Diliberto
authors.forename: Ari
authors.initials: A
authors.lastname: Melnick
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Knowles
authors.forename: Selina
authors.initials: S
authors.lastname: Chen-Kiang
authors.forename: Morton
authors.initials: M
authors.lastname: Coleman
authors.forename: John P
authors.initials: JP
authors.lastname: Leonard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone