Context: EFS24 is an established endpoint in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) but its role is undefined in MCL. Objective: To evaluate the prognostic role of EFS24 in MCL. Design: Prospective cohort study. Setting: Academic centers. Patients: Patients with newly diagnosed MCL in Era 1 (2002–2009, n=175) and Era 2 (2010–2015, n=168) from the Iowa/Mayo Lymphoma SPORE MER cohort. Interventions: Management per treating physician and prospective follow-up through MER. Main Outcome Measures: Overall survival (OS) compared to age- and sex-matched general US population and cause of death (COD). Results: Patients diagnosed in Era 2 had better OS compared to Era 1, with 5-year OS of 68.4% vs 59.2% (HR=0.68, 95%CI=0.50-0.93). Patients diagnosed in both eras had inferior OS compared to the general population, with a standardized mortality ratio (SMR) of 3.26 (95%CI= 2.70-3.89, P<0.001) in Era 1 and 2.63 (95%CI=2.03-3.36, P<0.001) in Era 2. Patients diagnosed in Era 1 who achieved EFS24 (n=98) still had inferior OS compared to the general population, with an SMR of 2.23 (95%CI=1.67-2.92, P<0.001). In contrast, patients diagnosed in Era 2 who achieved EFS24 (n=99) had similar OS compared to the general population, with an SMR of 1.31 (95%CI=0.78-2.07, P=0.31). The primary COD after diagnosis was lymphoma-related for patients diagnosed in both eras. The 5-year rate of lymphoma-related death was 28.8% in Era 1 and 20.5% in Era 2. In patients who were diagnosed in Era 1 and achieved EFS24, the primary COD after achieving EFS24 remained to be lymphoma-related, with a 5-year rate of 19.8% vs 6.2% for lymphoma-unrelated causes. In contrast, in patients who were diagnosed in Era 2 and achieved EFS24, the rate of lymphoma-related death was not higher than that of lymphoma-unrelated death, with a 5-year rate of 2.1% vs 5.5%. Conclusions: In the more recent era, patients who achieved EFS24 had survival approaching the general population. In addition, these patients had a low risk of dying from lymphoma and were more likely to die from other causes.
- cause of death
- event-free survival at 24 months (EFS24)
- mantle cell lymphoma
ASJC Scopus subject areas
- Cancer Research