Improving survival and narrowing age disparities in mantle cell lymphoma across therapeutic eras

Mantle cell lymphoma (MCL) is an aggressive subtype of B-cell non-Hodgkin lymphoma that predominantly affects older adults, with a median age at diagnosis of approximately 67 years and a marked male predominance [ 1 , 2 ]. Treatment outcomes have improved substantially over the past two decades with the incorporation of rituximab, cytarabine-based induction and autologous stem cell transplantation (ASCT) in selected patients [ 3 ], and Bruton tyrosine kinase inhibitors (BTKis) [ 4 ]. More recently, CAR-T therapies [ 5 ] have expanded options for relapsed/refractory disease, while randomized studies have challenged the necessity of ASCT in selected patients [ 6 , 7 ]. However, population-level survival gains across successive treatment eras, particularly among older, often transplant-ineligible patients, remain poorly defined, and the impact of therapeutic advances beyond the early BTKi era is unclear [ 8 ]. We therefore used the SEER-17 database to evaluate trends in MCL-specific mortality and survival from 2000 to 2023 across four therapeutic eras, with a focus on age-stratified outcomes.