Early relapse identifies MCL patients with inferior survival after intensive or less intensive frontline therapy

Although an expanding array of effective treatments has resulted in recent improvement in survival of patients with mantle cell lymphoma (MCL), outcomes remain heterogeneous, and identification of prognostic factors remains a priority. We assessed the prognostic impact of time to progression of disease (POD) afterfirst-line therapy among455 patients with relapsed MCL. Patients were categorized by duration of first remission as PRF/POD6, defined as progressive diseaseduringinduction orPODwithin6monthsof diagnosis (n565;14%);POD6-24, definedasPODbetween 6and24months after diagnosis (n5153; 34%);andPOD.24, defined asPOD.24monthsafterdiagnosis(n5237;53%).ThemedianoverallsurvivalfromPOD(OS2) was 1.3 years (95%confidence interval [CI], 0.9-2.4) for patients with PRF/POD6, 3 years (95% CI, 2-6.8) for those with POD6-24, and 8 years (95%CI, 6.2-NR) for those withPOD.24. Median OS2 was inferior in patients with early POD (defined as PRF/POD6 or POD6-24) after both intensive and less intensive frontline treatment. The prognostic performance of time until PODwasreplicated inanindependent cohort of 245 patients with relapsedMCL,withmedian OS2 of 0.3 years (95%CI, 0.1-0.5) for PRF/POD6, 0.8 years (95%CI, 0.6-0.9) for POD6-24, and 2.4 years (95%CI 2.1-2.7) for POD.24. Early POD is associated with inferior OS2 in patients with relapsed MCL, identifying a high-risk population for future prospective studies.