Real-world Evidence of Treatment Outcomes in Mantle Cell Lymphoma: A Single-center Experience in Southern Taiwan

Abstract Background: Mantle cell lymphoma (MCL) is a rare and aggressive B-cell lymphoma often diagnosed at an advanced stage. Standard first-line treatment includes bendamustine-rituximab or cytarabine-based regimens, sometimes followed by autologous stem cell transplantation (autoSCT). The TRIANGLE trial suggested that Bruton’s tyrosine kinase inhibitor (BTKi)-based, transplant-free strategies may be similarly effective. In Taiwan, the use of BTKis is limited to relapsed disease due to reimbursement policies. This study analyzes the characteristics, event-free survival from first-line treatment (EFS1), and the impact of BTKis on EFS from the start of second-line treatment (EFS2) in patients with MCL. Materials and Methods: This retrospective cohort study included 58 MCL patients treated at Kaohsiung Chang Gung Memorial Hospital from January 2001 to December 2023. Clinical characteristics, treatment regimens, and outcomes were reviewed using the electronic medical records. EFS1, EFS2, and overall survival (OS) were analyzed. Survival curves were generated using the Kaplan–Meier method. Results: The median age of the patients was 65 years and 81% were male. Most patients presented with advanced-stage disease (87.9%) and 47.3% were classified as high risk according to the MCL International Prognostic Index. The median OS (mOS) and EFS1 were 45.4 months and 14.2 months, respectively. Patients who underwent frontline autoSCT had better EFS; however, more follow-up data were needed to analyze the mOS. Comparisons of different first-line regimens (cytarabine, bendamustine, and bortezomib) were not conducted due to the small number of patients. In the second-line setting, treatment with BTKis was not superior to other therapies regarding EFS. Conclusion: In conclusion, our real-world data suggest that frontline autoSCT may improve EFS in patients with MCL. While BTKis remain standard in relapsed settings, their benefit over chemotherapy was not evident in this cohort. These findings reflect treatment patterns and outcomes in patients in southern Taiwan and further evaluations are needed.