title: Deferred therapy is associated with improved overall survival in patients with newly diagnosed mantle cell lymphoma.
abstract: Despite efforts at risk stratification in mantle cell lymphoma (MCL), most patients are treated aggressively at the time of diagnosis. Prior reports have suggested that a subset of patients with MCL may safely defer therapy. A national cohort analysis using the National Cancer Data Base was performed to evaluate the role of deferred therapy in MCL.
  
  
  
  Patients diagnosed with MCL between 2004 and 2011 were included, and they were divided into deferred-therapy (time from diagnosis to treatment > 90 days) and immediate-therapy groups. Differences between the groups were described with chi-square tests, and multivariate regression models were constructed to identify factors associated with deferred therapy and improved overall survival (OS).
  
  
  
  There were 8029 patients, and 492 (6%) received deferred therapy with a median time to initial treatment of 121 days (range, 91-1152 days). Patients who deferred therapy were more likely to have stage I or II disease and extranodal involvement and were less likely to have B symptoms. In addition, deferred patients were more likely to be treated at a high-volume teaching/research institution and to reside in the Northeast or West region. Deferred therapy was an independent predictor of OS for all patients with MCL. Among patients who deferred therapy, predictors of improved OS included male sex, a younger age, and a lack of comorbidities.
  
  
  
  Deferred therapy is a safe option for a subset of patients with MCL. Further study is required to better identify the best candidates for deferred therapy according to baseline risk stratification in MCL. Cancer 2016;122:2356-2363. © 2016 American Cancer Society.
authors.affiliation: Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.
authors.forename: Jonathon B
authors.initials: JB
authors.lastname: Cohen
authors.affiliation: American Cancer Society, Atlanta, Georgia.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Han
authors.affiliation: American Cancer Society, Atlanta, Georgia.
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
authors.affiliation: American Cancer Society, Atlanta, Georgia.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Ward
authors.affiliation: Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D061665:Time-to-Treatment; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: National Cancer Data Base; deferred therapy; mantle cell lymphoma; non-Hodgkin lymphoma; risk stratification