Real Egyptian Single-Center Experience in Mantle Cell Lymphoma Diagnosis and Management

Mantle cell lymphoma (MCL) is a heterogeneous disease with variable clinical presentations, pathological types, and molecular characteristics. Survival rates have improved with the emergence of novel therapies, but rates of relapsed and refractory disease remain high in developing countries due to lack of easy availability of newer therapeutic agents due to financial and logistical constraints. In this manuscript, we present a single-center retrospective data from an Egyptian tertiary care hospital and discuss our experience with managing MCL patients and factors affecting their outcomes.

This was a retrospective study that has been conducted on 69 cases of newly diagnosed MCL patients who attended the Oncology Centre Mansoura University (OCMU) from April 2011 to April 2023. Detailed history, clinical examination, basic and advanced laboratory and radiological investigations were performed at diagnosis. Patients received treatment according to the institutional protocols in the form of RCHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone] and RDHAP [rituximab, dexamethasone, high dose cytarabine and cisplatin] as induction therapy and ICE [ifosfamide, carboplatin, etoposide], ESHAP [etoposide, methylprednisolone, high dose cytarabine and cisplatin], gemcitabine-based protocols, and others as second line therapies. Some patients received metronomic therapies or received the best supportive care (BSC). The response was evaluated based on Lugano response criteria. The primary end point is to evaluate characteristics of MCL patients in Egyptian center with determination of some prognostic factors and secondary end point is evaluation of the overall survival (OS) and the factors influencing it.

In our study, we demonstrated many factors that had an impact on the OS, they were categorized into factors related to the patient, factors related to the clinical course of the disease, factors related to laboratory markers and treatment related factors. Old age (≥ 65 years) was associated with an inferior survival rate with a median of 29 months (95% CI;16-45.2) with p-value = 0.044 The patients who received R-CHOP ± R-DHAP had a superior OS with a median of 64mo (95% CI; 64-75.3) and 22mo (95% CI; 16-55) respectively than the patients who received other protocols, mainly the COP [cyclophosphamide, vincristine and prednisone]and best supportive care (BSC) who experienced the most inferior OS with a p-value = 0.0016. The relapse was associated also with an inferior median OS of 22mo (95% CI; 16-60) with a significant p-value = 0.025. The patients who received only one line of chemotherapy showed a superior OS with a median of 55mo (95% CI; 35-75.3) in comparison to patients who received more than one line of chemotherapy with a median OS of 22mo (95% CI; 16-43.2) with a significant p-value = 0.0012. SOX11 expression was associated with inferior OS with a median OS of 10mo (95% CI; 5-25.3) with p-value = 0.0052 . Cyclin D1 expression was associated with better OS than the patients associated with t(11:14) with a median OS of 55mo (95% CI; 34-75) and of p-value = 0.00063 . Lower hemoglobin levels ( p -value of 0.036) , lower platelet levels ( p -value of 0.0096) , and higher levels of lactate dehydrogenase (LDH) ( p -value of 0.012) were associated with dismal prognosis.

We concluded that multiple clinical, laboratory, and molecular factors can affect the survival of MCL such as old age, low hemoglobin, platelets levels, high LDH levels, SOX11 expression and lack of CyclinD1 expression. Other important factors are the type of induction chemotherapy, the response to treatment, and relapse status. To overcome the limitations in our study, larger cohorts are needed to be studied with the evaluation of the novel therapies when feasible. Enhancing financial support is crucial to improve MCL patients' care in our country.