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Treatment patterns and outcomes of unfit and elderly patients with Mantle cell lymphoma unfit for standard immunochemotherapy: A UK and Ireland analysis

Rampotas, Alexandros; Wilson, Matthew R.; Lomas, Oliver; Denny, Nicholas; Leary, Heather; Ferguson, Graeme; McKay, Pamela; Ebsworth, Tim; Miller, Jonathan; Shah, Nimish; Martinez‐Calle, Nicolas; Bishton, Mark; Everden, Angharad; Tucker, David; El‐Hassad, Ezzat; Hennessy, Brian; Doherty, Dearbhla; Prideaux, Steve; Faryal, Rehman; Hayat, Amjad; Keohane, Clodagh; Marr, Helen; Gibb, Adam; Pocock, Rachael; Lambert, Jonathan; Lacey, Rachel; Elmusharaf, Nagah; Clifford, Ruth; Eyre, Toby A.


Alexandros Rampotas

Matthew R. Wilson

Oliver Lomas

Nicholas Denny

Heather Leary

Graeme Ferguson

Pamela McKay

Tim Ebsworth

Jonathan Miller

Nimish Shah

Nicolas Martinez‐Calle

Mark Bishton

Angharad Everden

David Tucker

Ezzat El‐Hassad

Brian Hennessy

Dearbhla Doherty

Steve Prideaux

Rehman Faryal

Amjad Hayat

Clodagh Keohane

Helen Marr

Adam Gibb

Rachael Pocock

Jonathan Lambert

Rachel Lacey

Nagah Elmusharaf

Ruth Clifford

Toby A. Eyre


Mantle cell lymphoma (MCL) presenting in elderly, unfit patients represents a clinical challenge. Front-line ‘attenuated’ or low-intensity immunochemotherapy is often employed, although outcomes are relatively unexplored. We report outcomes of attenuated immunochemotherapy in 95 patients with MCL across 19 centres in the UK and Ireland considered unfit for full-dose rituximab-bendamustine or rituximab-cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP). Regimens examined were rituximab-cyclophosphamide, vincristine, prednisolone (R-CVP) (n=19), dose-attenuated R-CHOP (n=22), dose attenuated rituximab-bendamustine (n=24) and rituximab-chlorambucil (n=30). The primary outcome was progression-free survival (PFS). The secondary outcomes included overall response, overall survival (OS) and toxicity. The median (range) age was 79 (58–89)years and 50% were aged ≥80years. The median (range) Cumulative Illness Rating Scale-Geriatric score was 6 (0–24). The median PFS for all patients was 15months [95% confidence interval (CI) 8·7–21·2) and median OS was 31·4months (95% CI 19·7–43·2). By multivariable analysis (MVA), the only clinical factor associated with an inferior PFS was blastoid morphology [hazard ratio (HR) 2·90, P=0·01). Notably, higher treatment intensity (R-CHOP/R-bendamustine composite) provided an independently superior PFS compared with R-CVP/R-chlorambucil (MVA HR 0·49, P=0·02). Factors associated with inferior OS by MVA were Eastern Cooperative Oncology Group Performance Status (HR 2·14, P=0·04), blastoid morphology (HR 4·08, P=0·001) and progression of disease at <24months status (HR 5·68, P<0·001). Overall, survival after front-line dose-attenuated immunochemotherapy is unsatisfactory. Clinical trials investigating novel agents such as Bruton tyrosine kinase and B-cell lymphoma 2 inhibitors in this specific clinical setting are warranted.


Rampotas, A., Wilson, M. R., Lomas, O., Denny, N., Leary, H., Ferguson, G., …Eyre, T. A. (2021). Treatment patterns and outcomes of unfit and elderly patients with Mantle cell lymphoma unfit for standard immunochemotherapy: A UK and Ireland analysis. British Journal of Haematology, 194(2), 365-377.

Journal Article Type Article
Acceptance Date Apr 20, 2021
Online Publication Date May 7, 2021
Publication Date 2021-07
Deposit Date Dec 15, 2022
Journal British Journal of Haematology
Print ISSN 0007-1048
Electronic ISSN 1365-2141
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 194
Issue 2
Pages 365-377
Keywords Hematology
Public URL
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