Outcomes of Patients with Blastoid and Pleomorphic Variant Mantle Cell Lymphoma.

Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma; data indicates that blastoid and pleomorphic variants have a poor prognosis. We report characteristics and outcomes of patients with blastoid/pleomorphic variants of MCL. We retrospectively studied adults with newly diagnosed MCL treated from 2000-2015. Primary objectives were to describe progression-free survival (PFS) and overall survival (OS). Secondary objectives included characterization of patient characteristics and treatments. Of 1029 MCL patients studied, a total of 207 neoplasms were blastoid or pleomorphic variant. Median follow up was 82 months (range 0.1-174 months); median PFS was 38 months (95% confidence interval [CI] 28-66) and OS 68 months (95% CI 45-96). Factors associated with PFS were receipt of consolidative autologous hematopoietic transplant (auto-HCT) (hazard ratio [HR] 0.52, 95% CI 0.31-0.80, p < 0.05), MCL International Prognostic Index (MIPI) score intermediate (HR 2.3, 95% CI 1.2-4.3, p<0.02) and high (HR 3.8, 95% CI 2.0-7/4, p<0.01), and complete response to induction (HR 0.29 (95% CI 0.17-0.51). Receipt of auto-HCT was not associated with OS (HR 0.69, 95% CI 0.41-1.16, p = 0.16), but was with MIPI intermediate (HR 5.7, 95% CI 2.5-13.2, p< 0.01) and high (HR 10.8, 95% CI 4.7-24.9, p< 0.01). We report outcomes in a large cohort of patients with blastoid/pleomorphic variant MCL. Receipt of auto-HCT after induction was associated with improved PFS for eligible patients, but not OS. Higher MIPI score and auto-HCT ineligibility were associated with worse survival.