Racial disparities on incidence and survival in Mantle Cell Lymphoma: A surveillance, epidemiology and end results program database (2013-2022) retrospective analysis

Abstract Background: Mantle cell lymphoma (MCL) is a rare and aggressive subtype of B-cell non-Hodgkin lymphoma, accounting for approximately 5% of all non-Hodgkin lymphomas. Since 2013, the therapeutic landscape for MCL has evolved with FDA approvals of novel treatments, including lenalidomide, Bruton tyrosine kinase inhibitors, and anti-CD19 chimeric antigen receptor T-cell therapy, aimed at improving patient outcomes. Despite these advances, the 5-year overall survival rate remains modest at 58–60%. Existing literature highlights persistent disparities in treatment access and outcomes, particularly across racial and socioeconomic groups. This study seeks to evaluate incidence and survival disparities among MCL patients aged 50–90 years who received chemotherapy in the United States, using data from the Surveillance, Epidemiology, and End Results (SEER) Program (2013–2022). Methods: Data were extracted from the SEER-21 registry (2013–2022) and analyzed using SEER*Stat 9.0.41.4 to calculate age-adjusted incidence and mortality rates per 100,000 population. A multiple regression analysis was performed in SPSS Version 24 to predict survival time (in months) based on sex, race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Asian/Pacific Islander, American Indian/Alaska Native), annual household income (<$50,000, $50,000–$100,000, >$100,000), and residential area (metropolitan vs. non-metropolitan). Statistical significance was set at p < 0.05. Results: Non-Hispanic White group had the highest age-adjusted incidence rate at 1.1 per 100,000 [95% CI, 1.1-1.2], followed by American Indian/Alaska Natives at 0.9 per 100,000 [95% CI, 0.6-1.3], Hispanics at 0.8 per 100,000 [95% CI, 0.7-0.9], Asian/Pacific Islander at 0.4 per 100,000 [95% CI, 0.4-0.5] and Non-Hispanic Black group at 0.4 per 100,000 [95% CI, 0.3-0.5]. Mortality rate was highest in the Non-Hispanic White and Hispanic groups at 0.1 per 100,000 [95% CI, 0.1-0.1] followed by American Indian/Alaska Natives at 0.1 per 100,000 [95% CI, 0.0-0.2] and with Black and Asian/Pacific Islander at 0.0 per 100,000 [95% CI, 0.0-0.1]. The multiple regression model significantly predicted survival time (F(7, 4061) = 13.228, p < 0.005, adjusted R² = 0.02). Age and race/ethnicity were statistically significant predictors (p < 0.05). Each additional year of age was associated with a 0.256-month decrease in survival (95% CI, -0.312 to -0.200; p < 0.001). Compared to Non-Hispanic Whites, Non-Hispanic Black patients experienced a 2.92-month reduction in survival (95% CI, -5.528 to -0.324; p = 0.028), and Hispanic patients had a 2.30-month reduction (95% CI, -3.808 to -0.790; p = 0.003). Other variables, including sex, income, and residential area, did not reach statistical significance. Conclusion: This large, population-based study reveals significant racial disparities in both incidence and survival of MCL, with non-Hispanic Black and Hispanic patients experiencing shorter survival compared to their non-Hispanic White counterparts. These findings underscore the impact of social determinants of health on cancer outcomes and highlight the urgent need for equitable access to advanced therapies. Further research is warranted to elucidate the mechanisms driving these disparities and to inform targeted interventions.