Impact of treatment facility type on survival outcomes in elderly patients with mantle cell lymphoma: A National Cancer Database analysis.

e19067 Background: Mantle cell lymphoma (MCL) is a rare non-Hodgkin lymphoma affecting older adults and associated with poor long-term outcomes despite frontline chemo-immunotherapy (1). Patients aged ≥75 years are underrepresented in clinical trials, and real-world data evaluating outcomes by treatment setting in this population are limited. Using the National Cancer Database (NCDB), we examined differences in treatment patterns and overall survival (OS) among elderly patients with MCL treated at Academic Cancer Programs (ACP) versus Community Cancer Programs (CCP). Methods: We conducted a retrospective cohort study of patients ≥75 years diagnosed with MCL between 2004 and 2022. Patients were stratified by treatment facility type: ACP and CCP. Demographic, socioeconomic, clinical, and treatment variables were compared. Kaplan-Meier analysis and Cox proportional hazards models were used to estimate OS, adjusting for age, race/ethnicity, insurance status, Charlson-Deyo comorbidity score, and distance from the treating facility. Results: A total of 12,167 patients were identified (6,072 treated at ACP and 6,095 at CCP). Median age was 80 years in both cohorts; most were male (66%, p=0.044) and non-Hispanic. Patients treated at ACP resided in metropolitan areas, had higher-income and education levels, and traveled longer distances for care (9.3 vs. 7.7 miles, p<0.001). Medicare was the primary payor in both cohorts (>86%). Across both facility types, more than half of cases presented with advanced-stage lymphoma (stage IV) and comorbidity burden was low (69% of patients had Charlson–Deyo score 0). Patients treated at ACP were slightly more likely to receive active treatment than those treated at CCP (60% vs 57%, p < 0.001). Time to treatment initiation was similar across facility types. Median follow-up was 22 months. OS was longer in patients treated at ACP (median OS 2.5 vs 2.1 years). Two-, five, and ten-year OS rates favored ACP (55% vs 51%; 31% vs 28%; 12% vs 10%; log-rank p<0.001). Conclusions: In this national cohort of patients aged ≥75 years with MCL, OS differed by facility type, with a modest but statistically significant survival advantage at ACPs. These differences may reflect patient selection, access to clinical trials, specialized expertise and multidisciplinary care. Given poor outcomes and limited durability of standard therapies in older adults with MCL, strengthening collaboration between ACP and CCP is critical to improving access to high-quality care and novel strategies. Prospective studies are warranted to validate these findings and improve equity and outcomes in this vulnerable population.