Dp002 | Fitness Status and Time to First Progression in Elderly Patients With Mantle Cell Lymphoma: Results From the “elderly Mantle-first” Study
Year: 2025
Type: article
Abstract: Mantle cell lymphoma (MCL) is an incurable disease. Elderly patients represent the majority of cases, with heterogeneous but unsatisfactory outcomes. We aimed to confirm the prognostic impact of time to first progression of disease (early-POD ≤ 24 months versus late-POD > 24 months) in a multicenter cohort of elderly patients with MCL, and to assess the role of fitness status, defined by a simplified geriatric assessment (sGA). We collected a real-life series of 231 MCL patients aged ≥65 years, that experienced first relapse or were refractory to frontline non-intensive chemo-immunotherapy (CIT). We evaluated the safety and effectiveness of different second-line treatments, and compared Bruton Tyrosine Kinase inhibitors (BTKi) (124 patients) versus salvage CIT (65 patients). The median progression free survival (PFS) after BTKi was significantly longer compared to CIT (1.39 versus 0.98 years, p-value 0.037), though slightly inferior to reports from the literature, possibly due to the median age of our cohort (77 years) and to the inferior fitness status (>50% unfit/frail). Early-POD patients showed a dismal prognosis, with a median PFS from second-line therapy (PFS-2) of 0.66 years versus 1.47 years for late-POD cases (p-value 0.007), and a median overall survival from second-line therapy (OS-2) of 1.34 years versus 3.17 years (p-value 0.007) (Figure 1. A, B). Fitness status emerged as crucial prognostic parameter (Figure 1. C, D). Fit patients with late relapse had the best prognosis (3-year PFS-2 34%, OS-2 62%), whereas unfit/frail patients showed quite similar outcomes regardless of time to POD. In conclusion, in a real-life cohort of elderly patients with MCL, we confirmed the role of BTKi as standard salvage therapy and the prognostic impact of early-POD. Moreover, fitness status emerged as an essential prognostic tool, apparently stronger than time to POD, and should be incorporated in future clinical trials.
Authors: (F.M. Quaglia, A. Arcari, L. Morello )*, L. Marcheselli, A. Tucci, C. Pagani, V. Bozzoli, G. Scapinello, V.R. Zilioli, C. Muzi, B. Puccini, B. Sordi, M.C. Tisi, N. Rampi, A. Castellino, S.V. Usai, J. Paternoster, E. Cencini, S. Ferrero, C. Consoli, M. Basso, E. Lucchini, E. Pennese, M.E. Nizzoli, M. Spina, L. Pezzullo, M.S. De Candia, R. Tavarozzi, M. Krampera, C. Visco
Institutions: Azienda Ospedaliera Universitaria Integrata Verona, Guglielmo da Saliceto Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Padua, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Azienda Ospedaliero-Universitaria Careggi, Ospedale San Bortolo, University of Milan, Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo, Azienda Ospedaliera G. Brotzu, University of Verona, University of Siena, Azienda Ospedaliera Universitaria Senese, University of Turin, Istituto Oncologico Veneto, Azienda sanitaria universitaria Giuliano Isontina, Ospedale di Santo Spirito, University of Modena and Reggio Emilia, Azienda Unita' Sanitaria Locale Di Modena, Centro di Riferimento Oncologico, AOU San Giovanni di Dio e Ruggi d'Aragona, Istituto Tumori Bari, Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7093122240
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