P Abrisqueta1, D W Scott2, G W Slack3, C Steidl4, A Mottok4, R D Gascoyne3, J M Connors2, L H Sehn2, K J Savage2, A S Gerrie5, D Villa6. 1. Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada;; Department of Hematology, Vall d'Hebron University Hospital, Barcelona, Spain. 2. Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada;; Division of Medical Oncology, British Columbia Cancer Agency, Vancouver. 3. Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada;; Department of Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver. 4. Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada. 5. Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada;; Division of Medical Oncology, British Columbia Cancer Agency, Vancouver;; Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver, Canada. 6. Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada;; Division of Medical Oncology, British Columbia Cancer Agency, Vancouver;. Electronic address: dvilla@bccancer.bc.ca.
Abstract
BACKGROUND: Patients with mantle cell lymphoma (MCL) follow a heterogeneous clinical course. While they generally require treatment initiation shortly after diagnosis, it is unclear whether deferring treatment in selected patients with an indolent clinical behavior affects their overall outcome. PATIENTS AND METHODS: In this population-based study, all patients diagnosed with MCL during 1998-2014 were identified in the British Columbia Cancer Agency Lymphoid Cancer Database. The associations between clinico-pathologic characteristics, including the expression of Ki67, SOX11, and TP53, and time to treatment (TtT) and OS were analyzed. RESULTS: A total of 440 patients with MCL were evaluated: 365 (83%) received early treatment and 75 (17%) were observed ≥3 months. In the observation group, 54 (72%) patients had a nodal presentation, 16 (21%) a non-nodal presentation, and 5 (7%) had only gastrointestinal involvement. Characteristics associated with deferred treatment included good performance status, no B symptoms, low LDH, non-bulky disease, non-blastoid morphology, and lower Ki67 values. The median TtT in the observation group was 35 months (range 5-79), and 60 (80%) patients were observed beyond 12 months. The median OS was significantly longer in the observation group than in the early treatment group (72 versus 52.5 months, respectively, P = 0.041). In multivariable analysis, treatment decision was not associated with OS [HR 0.804 (95% CI 0.529-1.221), P = 0.306]. CONCLUSIONS: A subgroup of patients with MCL may be safely observed from diagnosis without negatively impacting their outcomes, including patients with non-nodal presentation as well as asymptomatic patients with low burden nodal presentation and a low proliferative rate.
BACKGROUND: Patients with mantle cell lymphoma (MCL) follow a heterogeneous clinical course. While they generally require treatment initiation shortly after diagnosis, it is unclear whether deferring treatment in selected patients with an indolent clinical behavior affects their overall outcome. PATIENTS AND METHODS: In this population-based study, all patients diagnosed with MCL during 1998-2014 were identified in the British Columbia Cancer Agency Lymphoid Cancer Database. The associations between clinico-pathologic characteristics, including the expression of Ki67, SOX11, and TP53, and time to treatment (TtT) and OS were analyzed. RESULTS: A total of 440 patients with MCL were evaluated: 365 (83%) received early treatment and 75 (17%) were observed ≥3 months. In the observation group, 54 (72%) patients had a nodal presentation, 16 (21%) a non-nodal presentation, and 5 (7%) had only gastrointestinal involvement. Characteristics associated with deferred treatment included good performance status, no B symptoms, low LDH, non-bulky disease, non-blastoid morphology, and lower Ki67 values. The median TtT in the observation group was 35 months (range 5-79), and 60 (80%) patients were observed beyond 12 months. The median OS was significantly longer in the observation group than in the early treatment group (72 versus 52.5 months, respectively, P = 0.041). In multivariable analysis, treatment decision was not associated with OS [HR 0.804 (95% CI 0.529-1.221), P = 0.306]. CONCLUSIONS: A subgroup of patients with MCL may be safely observed from diagnosis without negatively impacting their outcomes, including patients with non-nodal presentation as well as asymptomatic patients with low burden nodal presentation and a low proliferative rate.
Authors: Jeff D Wang; Samuel G Katz; Elizabeth A Morgan; David T Yang; Xueliang Pan; Mina L Xu Journal: Hum Pathol Date: 2019-08-16 Impact factor: 3.466
Authors: Prasath Pararajalingam; Krysta M Coyle; Sarah E Arthur; Nicole Thomas; Miguel Alcaide; Barbara Meissner; Merrill Boyle; Quratulain Qureshi; Bruno M Grande; Christopher Rushton; Graham W Slack; Andrew J Mungall; Constantine S Tam; Rishu Agarwal; Sarah-Jane Dawson; Georg Lenz; Sriram Balasubramanian; Randy D Gascoyne; Christian Steidl; Joseph Connors; Diego Villa; Timothy E Audas; Marco A Marra; Nathalie A Johnson; David W Scott; Ryan D Morin Journal: Blood Date: 2020-07-30 Impact factor: 22.113
Authors: Hilka Rauert-Wunderlich; Anja Mottok; David W Scott; Lisa M Rimsza; German Ott; Wolfram Klapper; Michael Unterhalt; Hanneke C Kluin-Nelemans; Olivier Hermine; Sylvia Hartmann; Christoph Thorns; Grzegorz Rymkiewicz; Harald Holte; Martin Dreyling; Eva Hoster; Andreas Rosenwald Journal: Br J Haematol Date: 2018-08-10 Impact factor: 6.998
Authors: Diego Villa; Laurie H Sehn; Kerry J Savage; Cynthia L Toze; Kevin Song; Wendie D den Brok; Ciara L Freeman; David W Scott; Alina S Gerrie Journal: Blood Adv Date: 2020-08-11
Authors: Krithika Shanmugasundaram; Subir Goyal; Jeffery Switchenko; Oscar Calzada; Michael C Churnetski; Bhaskar Kolla; Veronika Bachanova; James N Gerson; Stefan K Barta; Max J Gordon; Alexey V Danilov; Natalie S Grover; Stephanie Mathews; Madelyn Burkart; Reem Karmali; Yazeed Sawalha; Brian T Hill; Nilanjan Ghosh; Steven I Park; Narendranath Epperla; David A Bond; Talha Badar; Kristie A Blum; Mehdi Hamadani; Timothy S Fenske; Mary Malecek; Brad S Kahl; Peter Martin; Jin Guo; Christopher R Flowers; Jonathon B Cohen Journal: Eur J Haematol Date: 2021-06-17 Impact factor: 2.997