Deferred therapy is associated with improved overall survival in patients with newly diagnosed mantle cell lymphoma

BACKGROUNDDespite efforts at risk stratification in mantle cell lymphoma (MCL), most patients are treated aggressively at the time of diagnosis. Prior reports have suggested that a subset of patients with MCL may safely defer therapy. A national cohort analysis using the National Cancer Data Base was performed to evaluate the role of deferred therapy in MCL. METHODSPatients diagnosed with MCL between 2004 and 2011 were included, and they were divided into deferred-therapy (time from diagnosis to treatment > 90 days) and immediate-therapy groups. Differences between the groups were described with chi-square tests, and multivariate regression models were constructed to identify factors associated with deferred therapy and improved overall survival (OS). RESULTSThere were 8029 patients, and 492 (6%) received deferred therapy with a median time to initial treatment of 121 days (range, 91-1152 days). Patients who deferred therapy were more likely to have stage I or II disease and extranodal involvement and were less likely to have B symptoms. In addition, deferred patients were more likely to be treated at a high-volume teaching/research institution and to reside in the Northeast or West region. Deferred therapy was an independent predictor of OS for all patients with MCL. Among patients who deferred therapy, predictors of improved OS included male sex, a younger age, and a lack of comorbidities. CONCLUSIONSDeferred therapy is a safe option for a subset of patients with MCL. Further study is required to better identify the best candidates for deferred therapy according to baseline risk stratification in MCL. Cancer 2016;122:2356-2363. (c) 2016 American Cancer Society.