Citations

Abstract Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma; data indicate that blastoid and pleomorphic variants have a poor prognosis. We report characteristics and outcomes of patients with blastoid/pleomorphic variants of MCL. We retrospectively studied adults with newly diagnosed MCL treated from 2000 to 2015. Primary objectives were to describe progression-free survival (PFS) and overall survival (OS). Secondary objectives included characterization of patient characteristics and treatments. Of the 1029 patients with MCL studied, a total of 207 neoplasms were blastoid or pleomorphic variants. Median follow-up period was 82 months (range, 0.1-174 months); median PFS was 38 months (95% confidence interval [CI], 28-66) and OS was 68 months (95% CI, 45-96). Factors associated with PFS were receipt of consolidative autologous hematopoietic transplantation (auto-HCT; hazard ratio [HR], 0.52; 95% CI, 0.31-0.80; P < .05), MCL International Prognostic Index (MIPI) intermediate (HR, 2.3; 95% CI, 1.2-4.3; P < .02) and high (HR, 3.8; 95% CI, 2.0-7.4; P < .01) scores, and complete response to induction (HR, 0.29 (95% CI, 0.17-0.51). Receipt of auto-HCT was not associated with OS (HR, 0.69; 95% CI, 0.41-1.16; P = .16) but was associated with MIPI intermediate (HR, 5.7; 95% CI, 2.5-13.2; P < .01) and high (HR, 10.8; 95% CI, 4.7-24.9; P < .01) scores. We report outcomes in a large cohort of patients with blastoid/pleomorphic variant MCL. For eligible patients, receipt of auto-HCT after induction was associated with improved PFS but not OS. Higher MIPI score and auto-HCT ineligibility were associated with worse survival.

Abstract Background: Prolymphocytic leukemia (PLL) is a rare cancer with incidence of 0.48/1,000,000. It is comprised of 2 subtypes, T or B cell. It generally is associated with a poor median OS of 1-3 years. However, some patients have an initial smoldering course not requiring treatment. Limited population data exists describing the outcomes of PLL. We studied PLL patients who met a definition of smoldering, not requiring treatment within 180 days of diagnosis, using the National Cancer Data Base (NCDB). Methods: Patient level data were obtained from the NCDB Participant User File. The NCDB collects hospital cancer registry data representing 70% of newly diagnosed cancer cases in the US population. We identified PLL patients (ICD-O: 9832 PLL, NOS, ICD-O: 9833 B-PLL, and ICD-O: 9834 T-PLL) diagnosed in 2004-2015 for demographics, disease and treatment characteristics. We included patients diagnosed from 2004-2013 in the overall survival (OS) analyses. Patients who received no treatment as part of their first course of treatment and who did not have a subsequent treatment within 180 days were considered smoldering PLL. Results: From 2004-2015, 1606 patients were diagnosed with PLL and 451(28%) were smoldering PLL. Of the 1606 patients, T-PLL represented 781(49%), B-PLL 480(30%), and PLL, NOS 345(21%). Of the 451 smoldering PLL patients observed as T-PLL represented 48%(215), B-PLL 29%(133), and PLL, NOS 23%(103). The median age at diagnosis was 69 [59 - 78] years. There was a male predominance with 60 % males. The median OS for the entire cohort was 20.6 months. The % 5yr overall survival (OS) for smoldering PLL was 40% vs 29%(for non-smoldering). Within the PLL subtypes PLL, NOS and B-PLL were associated with better 5yr OS 38.56% and 35.53%, compared to T-PLL 12.89%. Only 65(4%) patients underwent an early stem cell transplant(SCT). Conclusions: We identified a population of patients not needing treatment within 180 days of diagnosis representing smoldering PLL with a significantly improved OS. Additionally, PLL, NOS and B-PLL were associated with an improved OS. The use of early SCT is low in PLL. Disclosures No relevant conflicts of interest to declare.

PURPOSE Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger. PATIENTS AND METHODS We retrospectively studied transplantation-eligible adults age 65 years or younger with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to assess for improved progression-free survival (PFS) with AHCT consolidation and secondarily to assess for improved overall survival (OS). Cox multivariable regression analysis and propensity score–weighted (PSW) analysis were performed. RESULTS Data were collected from 25 medical centers for 1,254 patients; 1,029 met inclusion criteria. Median follow-up for the cohort was 76 months. Median PFS and OS were 62 and 139 months, respectively. On unadjusted analysis, AHCT was associated with improved PFS (75 v 44 months with v without AHCT, respectively; P < .01) and OS (147 v 115 months with v without AHCT, respectively; P < .05). On multivariable regression analysis, AHCT was associated with improved PFS (hazard ratio [HR], 0.54; 95% CI, 0.44 to 0.66; P < .01) and a trend toward improved OS (HR, 0.77; 95% CI, 0.59 to 1.01; P = .06). After PSW analysis, AHCT remained associated with improved PFS (HR, 0.70; 95% CI, 0.59 to 0.84; P < .05) but not improved OS (HR, 0.87; 95% CI, 0.69 to 1.1; P = .2). CONCLUSION In this large cohort of younger, transplantation-eligible patients with MCL, AHCT consolidation after induction was associated with significantly improved PFS but not OS after PSW analysis. Within the limitations of a retrospective analysis, our findings suggest that in younger, fit patients, AHCT consolidation may improve PFS.