Clinicopathological profile and prognostic subgrouping of mantle cell lymphomas: A six-year retrospective study from a tertiary care center in Kerala

ABSTRACT Background: Mantle cell lymphoma (MCL) is a rare mature B-cell non-Hodgkin lymphoma that is known to exhibit heterogeneous biological behavior and variable clinical outcomes. Ki-67 proliferation index, blastoid morphology, and p53 expression are important prognostic markers. Objectives: The primary objective was to analyze the clinicopathological spectrum of MCL cases diagnosed over 6 years at Amrita Institute of Medical Sciences, Kerala, India. The secondary objectives were to evaluate the prognostic significance of Ki-67 index and p53 immunohistochemical expression in MCL and to compare the clinicopathological features of classic and blastoid variants. Materials and Methods: This retrospective descriptive study included 21 histopathologically and immunohistochemically confirmed MCL cases diagnosed between January 2019 and December 2024. Clinical, morphological, immunophenotypic, treatment, and follow-up data were analyzed. Ki-67 was assessed in all cases, whereas p53 immunohistochemistry was performed in cases with Ki-67 >30%. Survival was estimated using Kaplan–Meier analysis and compared using the log-rank test. Associations were assessed using Chi-square or Fisher’s exact tests. Results: Fourteen patients were male and seven were female, with a mean age of 67.9 years, (standard deviation: 9.1), a median age of 70 years (interquartile range [IQR]: 60–76 years; range: 50–84 years). Classical MCL constituted 76.2% ( n = 16) of cases, while 23.8% ( n = 5) showed blastoid morphology. Advanced-stage disease was present in 57.1% ( n = 12) of patients. Ki-67 >30%, blastoid morphology, and p53 overexpression were associated with shorter progression-free survival. Conclusion: In MCL, aggressive disease and poorer survival outcomes were associated with blastoid morphology, high Ki-67, and p53 overexpression.