EFS24 is expected to be a prognostic factor for patients with initially treated mantle cell lymphoma

24-month event-free survival (EFS24) is an important clinical endpoint for the initial treatment of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL), and first-line immunochemotherapy has a longer
survival time for patients with EFS24 than in patients who did not achieve EFS24.
However, the prognostic role of EFS24 in mantle cell lymphoma (MCL) is unclear
.
Dr.
Yucai Wang of Myo Yoo Medical International (Mayo Clinic Medical Center) conducted a study to explore the prognosis of MCL patients in the "2002-2009" and "2010-2015" periods, and found that the development of first-line treatment was associated
with the improvement of EFS and "2010-2015" patient survival (OS) in two time periods.
Based on this, Dr.
Yucai Wang et al.
further explored the prognostic role of EFS24 in MCL
.

Patients with initial treatment of MCL who presented from September 2002 to June 2015 were screened from the Molecular Epidemiology Resource Bank (MER), Cohort 1 (2002-2009, n=175) and Cohort 2 (2010-2015, n=168).

Enrolling patients are managed according to the doctor's treatment options, with systematic follow-up every 6 months for the first 3 years and annually thereafter
.
OS is defined as the time from the time
of diagnosis (or an event as defined by EFS24) to death of any cause.

The median age of Cohort 1 patients was 64 years (range: 41-95) and the median age of Cohort 2 patients was 64 years (range 32-96), and the baseline characteristics of both groups of patients were shown in Table 1
.

Table 1 Patient baseline features

Cohort 2 patients had higher EFS and OS rates compared to Cohort 1 (5-year OS rate: 68.
4% vs 59.
2%; HR = 0.
68, 95% CI = 0.
50-0.
93) (Figure 1
).

Figure 1 EFS and OS of patients in different cohorts

Both cohorts had shorter post-diagnosis OS compared to the general population, with a standardized death-to-death ratio (SMR) of 3.
26 (95% CI = 2.
70-3.
89, P<0.
001) and an SMR of 2.
63 (95% CI = 2.
03-3.
36, P<0.
001) in Cohort 2 (Figure 2A-B).

。 The SMR of Cohort 1 patients after reaching EFS24 was 2.
23 (95% CI = 1.
67-2.
92, P<0.
001), and after reaching EFS24, the OS was similar to that of the general population, with an SMR of 1.
31 (95% CI = 0.
78-2.
07, P=0.
31) (Figure 2C-D).

Figure 2 Comparison of OS between cohort 1 and cohort 2 patients and the general population

The primary cause of death after diagnosis was lymphoma-related in two cohorts, with 5-year lymphoma-associated mortality in Cohort 1 and 20.
5% in Cohort 2 (Figures 3A-B).

The primary cause of death in patients reaching EFS24 in Cohort 1 remained lymphoma-related, with 5-year lymphoma-associated mortality of 19.
8% and 5-year non-lymphoma-associated mortality of 6.
1% (Figure 3C).

The primary cause of death of patients reaching EFS24 in cohort 2 was not lymphoma, with 5-year lymphoma-associated mortality of 2.
1% and 5-year non-lymphoma-associated mortality of 5.
5% (Figure 3D).

Figure 3 Causes of death in Cohort 1 and Cohort 2

The SMR of patients who reached EFS24 after receiving immunochemotherapy in Cohort 1 was 2.
89 (95% CI=2-4.
04, P<0.
001), and the SMR of patients who reached EFS24 after receiving immunochemotherapy in Cohort 2 was 0.
89 (95% CI=0.
43-1.
64, P=0.
82) (Figure 4A-B).

In addition, the main cause of death in patients who reached EFS24 after receiving immunochemotherapy in Cohort 1 remained lymphoma-related, with a 5-year lymphoma-related mortality rate of 20.
7% (Figure 4C).

The main cause of death in patients who reached EFS24 after receiving immunochemotherapy in cohort 2 was not associated with lymphoma, with a 5-year lymphoma-associated mortality rate of 1.
3% (Figure 4D).

Figure 4 OS comparison and causes of death in patients who achieve EFS24 after immunochemotherapy with the general population

Survival outcomes have improved in patients with initial MCL in more recent time periods (cohort 2), which may be related
to recent advances in first-line and salvage care for MCL.
Patients with EFS24 in cohort 2 have an OS close to the general population and a lower
risk of dying from lymphoma.
In the future, longer follow-up and external validation are needed to confirm the prognostic role
of EFS24 in patients with initial MCL.
With the continuous development of salvage therapy, OS in MCL patients is likely to continue to improve, and EFS24 is expected to become an important clinical endpoint for first-line treatment of MCL
.

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