Options for Program Chemotherapy and Their Outcomes in Patients with Newly Diagnosed Mantle Cell Lymphoma Based on the Data from a Single Center

AIM. To assess the clinical characteristics and efficacy of chemotherapy for patients with newly diagnosed mantle cell lymphoma (MCL) based on the data from a single center. MATERIALS & METHODS. The study enrolled 60 MCL patients treated at the NN Blokhin National Medical Cancer Research Center from 2008 to 2024. The patients were 37–79 years of age (median 58 years); there were 22 women and 38 men. According to MIPI, there were 18 (30 %) low risk, 22 (37 %) intermediate risk, and 20 (33 %) high risk patients. Intensified regimens with high-dose cytarabine were administered to 31 (52 %) patients, whereas standard non-intensified R-CHOP, R-B, R-BAC and similar regimens were used in 29 (48 %) patients. Autologous hematopoietic stem cell transplantation (auto-HSCT) was performed in 18 (30 %) patients after completing 6 cycles of induction immunochemotherapy. Maintenance rituximab therapy was assigned to 36 (60 %) patients. Ibrutinib, one of Bruton’s tyrosine kinase inhibitors, was added to basic immunochemotherapy in 11 (18 %) patients. RESULTS. The 3-year progression-free survival (PFS) of the recipients of intensified regimens with high-dose cytarabine was 73 % vs. 54 % (p < 0.05) shown by the recipients of the above listed standard non-intensified treatment protocols. The 3-year PFS of elderly recipients of bendamustine-based treatment was 64 % vs. 25 % shown by the patients treated with R-CHOP/R-CHOP-like regiments (p = 0.05). The 3-year PFS of recipients and non-recipients of maintenance rituximab therapy was 86 % and 33 %, respectively (p = 0.001). In the groups of recipients and non-recipients of auto-HSCT, it was reported to be 76 % and 56 % (p = 0.05). In the total group (n = 60), with the follow-up median of 36 months, the 3-year PFS was 64 % (median 54 months), and the 3-year OS was 80 % (median 84 months). The 3-year PFS rates in MCL patients varied considerably at different historic stages and were 42 % during the period from 2008 to 2017 and 86 % from 2018 to 2024 (p = 0.02). CONCLUSION. The present study covers the period of 16 years characterized by changing approaches to MCL treatment. The 3-year PFS rate of 86 % in the period of 2018–2024 increased nearly twofold compared to 2008–2017. Intensified program MCL first-line therapy with high-dose cytarabine significantly improves the long-term outcomes as opposed to standard immunochemotherapy (R-CHOP, R-B, etc.). For elderly MCL patients, bendamustine-based regimens appear to be most effective. Irrespective of patient’s age, it should be recognized that ibrutinib added to basic MCL chemotherapy holds the most promise. Maintenance rituximab therapy is a must in program treatment. Consolidation auto-HSCT performed after basic immunochemotherapy is associated with higher rates of long-term survival. The present study yielded results comparable to international data and showing a high reproducibility in real-world clinical practice.