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Disease progression more than 6 years after treatment impacts overall survival in mantle cell lymphoma

Ekberg, Sara ; Glimelius, Ingrid ; Albertsson-Lindblad, Alexandra LU ; Smedby, Karin E. ; Jerkeman, Mats LU and Dietrich, Caroline E. (2025) In International Journal of Cancer
Abstract

Studies on mantle cell lymphoma (MCL) emphasize that patients with progression of disease (POD) ≤24 months have inferior prognosis compared to patients with later POD. This population-based study assessed the impact of POD on overall survival (OS) by timing of progression and first-line treatment. A total of 1186 MCL patients diagnosed 2006–2018 were identified in the Swedish lymphoma register. POD was defined as progressive disease after first-line treatment or relapse following initial response. Hazard ratios (HRs) with 95% confidence intervals (CIs), comparing all-cause mortality among patients with and without POD, were estimated with Cox regression. An illness-death model was used to quantify the impact of timing of progression on... (More)

Studies on mantle cell lymphoma (MCL) emphasize that patients with progression of disease (POD) ≤24 months have inferior prognosis compared to patients with later POD. This population-based study assessed the impact of POD on overall survival (OS) by timing of progression and first-line treatment. A total of 1186 MCL patients diagnosed 2006–2018 were identified in the Swedish lymphoma register. POD was defined as progressive disease after first-line treatment or relapse following initial response. Hazard ratios (HRs) with 95% confidence intervals (CIs), comparing all-cause mortality among patients with and without POD, were estimated with Cox regression. An illness-death model was used to quantify the impact of timing of progression on OS, conditional on the timepoint of POD/PF (progression-free). Patients were followed for up to 10 years following treatment (median 3.7 years). BR, Nordic MCL2, and R-CHOP/R-CHOP-like treatment were administered to 33%, 30%, and 14% of patients. Almost half (48%, n = 572) of patients experienced POD, with consequently higher mortality, regardless of timing and treatment (adjusted HR = 7.56, 95% CI: 6.32–9.05). Importantly, even for patients with POD after 6–10 years, mortality was more than two-fold increased (HR = 2.67, 95% CI: 1.05–6.79). On the absolute scale, a survival difference persisted for progression occurring up to 9 years after primary treatment. Especially early but also late progression (well beyond the 24-month mark) has a large negative impact on survival in MCL. These results highlight the need for improved first-line, including maintenance therapies to sustain remission and optimize outcomes for MCL patients.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
mantle cell lymphoma, POD, survival
in
International Journal of Cancer
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:105021336946
  • pmid:41189519
ISSN
0020-7136
DOI
10.1002/ijc.70220
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.
id
5f72f691-bca9-47e9-aeb8-7ae0d1e8867e
date added to LUP
2025-12-19 14:23:03
date last changed
2025-12-19 14:24:21
@article{5f72f691-bca9-47e9-aeb8-7ae0d1e8867e,
  abstract     = {{<p>Studies on mantle cell lymphoma (MCL) emphasize that patients with progression of disease (POD) ≤24 months have inferior prognosis compared to patients with later POD. This population-based study assessed the impact of POD on overall survival (OS) by timing of progression and first-line treatment. A total of 1186 MCL patients diagnosed 2006–2018 were identified in the Swedish lymphoma register. POD was defined as progressive disease after first-line treatment or relapse following initial response. Hazard ratios (HRs) with 95% confidence intervals (CIs), comparing all-cause mortality among patients with and without POD, were estimated with Cox regression. An illness-death model was used to quantify the impact of timing of progression on OS, conditional on the timepoint of POD/PF (progression-free). Patients were followed for up to 10 years following treatment (median 3.7 years). BR, Nordic MCL2, and R-CHOP/R-CHOP-like treatment were administered to 33%, 30%, and 14% of patients. Almost half (48%, n = 572) of patients experienced POD, with consequently higher mortality, regardless of timing and treatment (adjusted HR = 7.56, 95% CI: 6.32–9.05). Importantly, even for patients with POD after 6–10 years, mortality was more than two-fold increased (HR = 2.67, 95% CI: 1.05–6.79). On the absolute scale, a survival difference persisted for progression occurring up to 9 years after primary treatment. Especially early but also late progression (well beyond the 24-month mark) has a large negative impact on survival in MCL. These results highlight the need for improved first-line, including maintenance therapies to sustain remission and optimize outcomes for MCL patients.</p>}},
  author       = {{Ekberg, Sara and Glimelius, Ingrid and Albertsson-Lindblad, Alexandra and Smedby, Karin E. and Jerkeman, Mats and Dietrich, Caroline E.}},
  issn         = {{0020-7136}},
  keywords     = {{mantle cell lymphoma; POD; survival}},
  language     = {{eng}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{International Journal of Cancer}},
  title        = {{Disease progression more than 6 years after treatment impacts overall survival in mantle cell lymphoma}},
  url          = {{http://dx.doi.org/10.1002/ijc.70220}},
  doi          = {{10.1002/ijc.70220}},
  year         = {{2025}},
}