MCL-027 Prognostic Role of Event-free Survival at 24 Months (EFS24) in Newly Diagnosed Mantle Cell Lymphoma (MCL)

Abstract

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. With more efficacious salvage treatment options and likely continued improvement of OS, EFS24 may become an important clinical endpoint in frontline therapy of MCL