Therapeutic options and clinical outcomes of 1261 patients with mantle cell lymphoma in China ： a real-world retrospective multicenter analysis from Chinese Hematologist and Oncologist Innovation Cooperation of the excellent (CHOICE)

Abstract Background: Mantle cell lymphoma (MCL) is a rare and aggressive subtype of non-Hodgkin B-cell lymphoma and therapeutic options of MCL are limited. We conducted a real-world, multicenter study enrolled 1261 MCL patients from nine medical centers in China to evaluate patients’ outcomes.Methods: This retrospective study enrolled 1261 adult MCL patients between January 2000 and December 2020 from nine medical centers in China. Patients’ characteristics, treatment and survival outcomes were evaluated. Results:145 patients (11%) received Bruton’s tyrosine kinase inhibitors (BTKi)-containing regimens as frontline therapy. 12% of the younger patients received autologous hematopoietic stem cell transplantation (AHCT) consolidation. The estimated 2-year progression-free survival (PFS) and 5-year overall survival (OS) rate from the initiation of front-line treatment for the entire cohort was 62.4% and 57.2% respectively. Age≥65 years, high-risk Mantle Cell Lymphoma International Prognostic Index (MIPI), Ki-67>30% and blastoid/pleomorphic histology were associated with shorter PFS or OS. For younger patients, induction therapy with BTKi-containing regimens yield similar efficacy in 3-year PFS and OS as compared to the standard high-dose immunochemotherapy with AHCT (65.5% vs 66.6%, p=0.907 and 84.8% vs 92.3%, p=0.204). For the relapsed or refractory MCL patients in this cohort, the 5-year OS from the initiation of salvage therapy was 36.0%. A total of 23 patients developed hepatitis B virus (HBV) reactivation after immunochemotherapy, while BTKi treatment was not associated with higher rate of HBV reactivation. Conclusions:In conclusion, for younger Chinese MCL patients, the addition of BTKi in frontline therapy is a safer and more convenient alternative treatment strategy. For MCL patients with resolved hepatitis B, anti-HBV prophylaxis should not be neglected.