Originally published as JCO Early Release 10.1200/JCO.2008.19.6121 on February 2 2009

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Outcome of Deferred Initial Therapy in Mantle-Cell Lymphoma

From the Center for Lymphoma and Myeloma, Divisions of Hematology and Medical Oncology and Biostatistics and Epidemiology, and Departments of Medicine, Pathology, Laboratory Medicine, and Public Health, Weill Cornell Medical College; and New York Presbyterian Hospital, New York, NY.

Corresponding author: John P. Leonard, MD, Starr Building Rm 340, Weill Cornell Medical College and New York Presbyterian Hospital, 520 E 70th St, New York, NY 10021; e-mail: jpleonar{at}med.cornell.edu.

Purpose Treatment of mantle-cell lymphoma (MCL) is nonstandardized, though patients are commonly treated immediately at diagnosis. Because data on observation, or "watch and wait," have not been previously reported, we analyzed the outcome of deferred initial therapy.

Patients and Methods Inclusion criteria in this retrospective analysis were a diagnosis of MCL between 1997 and 2007 and known date of first treatment. Hospital and research charts were reviewed for prognostic and treatment-related information. Date of death was derived from hospital records and confirmed using an online Social Security death index.

Results Of 97 patients with MCL evaluated at Weill Cornell Medical Center, 31 patients (32%) were observed for more than 3 months before initial systemic therapy, with median time to treatment for the observation group of 12 months (range, 4 to 128 months). The observation group (median follow-up, 55 months) had a median age of 58 years (range, 40 to 81 years). Prognostic factors in assessable patients included advanced stage (III/IV) in 75%, elevated lactate dehydrogenase in 25%, and intermediate- or high-risk Mantle Cell International Prognostic Index in 54%. Better performance status and lower-risk standard International Prognostic Index scores were more commonly present in those undergoing observation. Although time to treatment did not predict overall survival in a multivariate analysis, the survival profile of the observation group was statistically superior to that of the early treatment group (not reached v 64 months, P = .004).

Conclusion In selected asymptomatic patients with MCL, deferred initial treatment ("watch and wait") is an acceptable management approach.

Supported by a Terry Fox fellowship from the National Cancer Institute of Canada (P.M.) and grants from the Lymphoma Research Foundation and the Lymphoma Foundation (J.P.L.).

Presented in part at the plenary session of the 10th International Conference on Malignant Lymphoma, 4-7 June, 2008, Lugano, Switzerland.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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