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. 2023 Dec 26;7(24):7393-7401.
doi: 10.1182/bloodadvances.2023010757.

Outcomes of patients with blastoid and pleomorphic variant mantle cell lymphoma

James N Gerson  1   2 , Elizabeth Handorf  1 , Diego Villa  3 , Alina S Gerrie  3 , Parv Chapani  3 , Shaoying Li  4 , L Jeffrey Medeiros  4 , Michael Wang  4 , Jonathon B Cohen  5 , Michael Churnetski  5 , Brian T Hill  6 , Yazeed Sawalha  6 , Francisco J Hernandez-Ilizaliturri  7 , Shalin Kothari  7 , Julie M Vose  8 , Martin Bast  8 , Timothy Fenske  9 , Swapna Narayana Rao Gari  9 , Kami J Maddocks  10 , David Bond  10 , Veronika Bachanova  11 , Bhaskar Kolla  11 , Julio Chavez  12 , Bijal Shah  12 , Frederick Lansigan  13 , Timothy Burns  13 , Alexandra M Donovan  13 , Nina Wagner-Johnston  14 , Marcus Messmer  14 , Amitkumar Mehta  15 , Jennifer K Anderson  15 , Nishitha Reddy  16 , Alexandra E Kovach  16 , Daniel J Landsburg  2 , Martha Glenn  17 , David J Inwards  18 , Kay Ristow  18 , Reem Karmali  19 , Jason B Kaplan  19 , Paolo F Caimi  20 , Saurabh Rajguru  21 , Andrew Evens  22 , Andreas Klein  22 , Elvira Umyarova  23 , Bhargavi Pulluri  23 , Jennifer E Amengual  24 , Jennifer K Lue  24 , Catherine Diefenbach  25 , Richard I Fisher  1 , Stefan K Barta  1   2
Affiliations

Outcomes of patients with blastoid and pleomorphic variant mantle cell lymphoma

James N Gerson et al. Blood Adv. .

Abstract

Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma; data indicate 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 to 2015. Primary objectives were to describe progression-free survival (PFS) and overall survival (OS). Secondary objectives included characterization of patient characteristics and treatments. Of the 1029 patients with MCL studied, a total of 207 neoplasms were blastoid or pleomorphic variants. Median follow-up period was 82 months (range, 0.1-174 months); median PFS was 38 months (95% confidence interval [CI], 28-66) and OS was 68 months (95% CI, 45-96). Factors associated with PFS were receipt of consolidative autologous hematopoietic transplantation (auto-HCT; hazard ratio [HR], 0.52; 95% CI, 0.31-0.80; P < .05), MCL International Prognostic Index (MIPI) intermediate (HR, 2.3; 95% CI, 1.2-4.3; P < .02) and high (HR, 3.8; 95% CI, 2.0-7.4; P < .01) scores, 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 = .16) but was associated with MIPI intermediate (HR, 5.7; 95% CI, 2.5-13.2; P < .01) and high (HR, 10.8; 95% CI, 4.7-24.9; P < .01) scores. We report outcomes in a large cohort of patients with blastoid/pleomorphic variant MCL. For eligible patients, receipt of auto-HCT after induction was associated with improved PFS but not OS. Higher MIPI score and auto-HCT ineligibility were associated with worse survival.

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Conflict of interest statement

Conflict-of-interest disclosure: J.N.G. declares research funding from Loxo and consulting for Genetech. E.H. declares research funding from Pfizer (to institution). D.V. declares honoraria from Roche Canada, Janssen, Lundbeck Canada, Seattle Genetics, Gilead Sciences, Acerta Pharma/AstraZeneca, Celgene, and Merck; consulting for, or advisory role with Roche Canada, Janssen, Lundbeck Canada, Seattle Genetics, Gilead Sciences, Accerta Pharma/AstraZeneca, and Celgene; research funding from Roche (to institution); and travel, accommodation, and expenses funds from Roche Canada, Janssen, Lundbeck Canada, and Accerta Pharma. A.S.G. declare honoraria from Janssen; consulting for, or advisory role with Janssen, AbbVie, and Seattle Genetics; and research funding from AbbVie (to institution), Accerta (to institution), Roche Canada (to institution), and Lundbeck Canada (to institution). P.C. declares patents, royalties, and other intellectual property (intellectual property of recombinant oncoloytic viruses: the invention relates to recombinant oncolytic viruses; more specifically, the present invention relates to recombinant oncolytic viruses expressing a heterologous B-cell–attractant polypeptide or a T-cell–attractant polypeptide). M.W. declares honoraria from Janssen Research & Development, AstraZeneca, the National Cancer Institute, Medscape, and PeerView; consulting for or advisory role with AstraZeneca, Janssen Research & Development, Celgene, and MoreHealth; research funding from AstraZeneca, Janssen Research & Development, Pharmacyclics, Kite Pharma, Juno Therapeutics, BeiGene, Novartis, and Accerta Pharma; and travel, accommodation, and expense funds from Janssen Research & Development and AstraZeneca. J.B.C. declares consulting for, or advisory role with Pharmacyclics, Celgene, Millennium Pharmaceuticals, Seattle Genetics, Novartis, Infinity Pharmaceuticals, and AbbVie; and research funding from Bristol Myers Squibb, Janssen, Novartis, and Takeda Pharmaceuticals. B.T.H. declares honoraria from Pharmacyclics, Gilead Sciences, Genentech, AbbVie, Seattle Genetics, Bayer HealthCare Pharmaceuticals; consulting for, or advisory role with Seattle Genetics, Novartis, and AbbVie/Genentech; and research funding from AbbVie (to institution), Karyopharm Therapeutics (to institution), Celgene (to institution), Takeda Pharmaceuticals (to institution), and Amgen (to institution). F.J.H.-I. declares consulting for or advisory role with Celgene, Amgen, Seattle Genetics, Pharmacyclics, Takeda Pharmaceuticals, Novartis, and GlaxoSmithKline. S.K. declares stock and other ownership interests in Portola Pharmaceuticals. J.M.V. declares honoraria from Novartis, AbbVie, Epizyme, Roche, Legend Biotech, Karyopharm Therapeutics, Sandoz, Vaniam Group, Janssen Scientific Affairs, Kite Pharma/Gilead Sciences, Accerta Pharma/AstraZeneca, and Nordic Nanovector; consulting for or advisory role with Bio Connections; and research funding from Celgene (to institution), Genentech (to institution), Incyte (to institution), Accerta Pharma (to institution), Kite Pharma (to institution), Seattle Genetics (to institution), Novartis (to institution), Bristol Myers Squibb (to institution), Merck Sharp & Dohme (to institution), AstraZeneca. T.S.F. declares stock and other ownership interests in Merck; honoraria from Sanofi, AstraZeneca, Celgene, Adaptive Biotechnologies, Janssen Oncology, Seattle Genetics, and Genentech; consulting for or advisory role with Adaptive Biotechnologies, Janssen Oncology, Seattle Genetics, and Genentech; served on the speakers’ bureau for Sanofi, AstraZeneca, Seattle Genetics, and Celgene; and received travel, accommodation, and expenses funds from Sanofi, AstraZeneca, Celgene, Adaptive Biotechnologies, Janssen Oncology, Seattle Genetics, and Genentech. K.J.M. declares honoraria from Pharmacyclics, Bayer HealthCare Pharmaceuticals, Novartis, and Teva Pharmaceuticals Industries; and research funding from Pharmacyclics, Merck, Bristol Myers Squibb. V.B. declares consulting for or advisory role with Seattle Genetics, and Kite Pharma; research funding from Gamida Cell, Unum Therapeutics (to institution), Novartis (to institution); and received travel, accommodation, and expenses funds from Amgen. B.K. declares stock and other ownership interests in Amgen. J.C. declares consulting for, or advisory role with Kite Pharma/Gilead Sciences, Novartis, Genentech, and Bayer HealthCare Pharmaceuticals and is a member of the speaker’s bureau of Kite Pharma/Gilead Sciences, Novartis, Genentech, Janssen, and Merck. B.S. declares honoraria from Pharmacyclics/Janssen; consulting for or advisory role with Adaptive Biotechnologies; and research funding from Incyte, Jazz Pharmaceuticals (to institution). F.L. declares consulting for, or advisory role with Spectrum Pharmaceuticals, Celgene, and Seattle Genetics; and reports research funding from Spectrum Pharmaceuticals (to institution). N.W.-J. declares consulting for, or advisory role with Juno Therapeutics, ADC Therapeutics, Janssen Oncology, and Gilead Sciences; and reports research funding from Merck, Novartis/Pfizer, Genentech, and Astex Pharmaceuticals. A.M. declares stock and other ownership interests in Witty Health; consulting for, or advisory role with Spectrum Pharmaceuticals, Aileron Therapeutics, Bristol Myers Squibb, Seattle Genetics, Kite Pharma, and Carevive; is a member of the speaker’s bureau of Spectrum Pharmaceuticals, AstraZeneca, Kite Pharma, and Gilead Sciences; and reports research funding from Incyte (to institution), Roche/Genentech (to institution), Merck (to institution), Bristol-Myers Squibb (to institution), Juno Therapeutics (to institution), Gilead Sciences (to institution), Forty Seven (to institution), Takeda Pharmaceuticals (to institution), Astex Pharmaceuticals (to institution), Pharmacyclics/Janssen (to institution), Epizyme (to institution), Aileron Therapeutics (to institution), and Carevive (to institution). N.R. declares consulting for or advisory role with Celgene, AbbVie, Bristol Myers Squibb, Adaptive Biotechnologies; is a member of the speaker’s bureau of Gilead Sciences; and reports research funding from Bristol Myers Squibb (to institution). A.E.K. declares stock and other ownership interests in Lixte Biotechnology. D.J.L. declares consulting or advisory role with Celgene and Curis; and research funding from Takeda Pharmaceuticals (to institution), Triphase Accelerator (to institution), and Curis, Curis (to institution). M.G. declares employment with ExactSciences-; and research funding from Genentech. R.K. declares consulting for, or advisory role with Kite Pharma/Gilead Sciences, and Juno Therapeutics; is a member of the speaker’s bureau of AstraZeneca and Kite Pharma/Gilead Sciences; and received research funding from Bristol Myers Squibb (to institution) and Takeda Pharmaceuticals (to institution). J.B.K. declares consulting for, or advisory role with, Seattle Genetics; research funding from Janssen (to institution) and Seattle Genetics (to institution); and travel, accommodation, and expenses funds from Curis. P.F.C. declares consulting for, or advisory role with, Genentech/Roche and Kite Pharma; is a member of the speaker’s bureau of Spectrum Pharmaceuticals; and hold patents, receives royalties, and has other intellectual property with XaTEC as patent holder (I). A.E. declares honoraria from Seattle Genetics, Celgene, Spectrum Pharmaceuticals, Pharmacyclics, Affimed Therapeutics, Merck, Accerta Pharma, AbbVie, Janssen Biotech, Novartis, Bayer HealthCare Pharmaceuticals, Verastem, Kite Pharma/Gilead Sciences, and Research to Practice; consulting for, or advisory role with Celgene, Spectrum Pharmaceuticals, Seattle Genetics, Affimed Therapeutics, Merck, Kite Pharma, Janssen Oncology, Bayer HealthCare Pharmaceuticals, and AbbVie/Genentech; received research funding from Tesaro, Seattle Genetics, and Merck; and received travel, accommodation, and expenses funds from Seattle Genetics, Research to Practice, Bayer HealthCare Pharmaceuticals, Affimed Therapeutics, Pharmacyclics, Janssen Biotech, Novartis, Merck, Verastem, AbbVie/Genentech, Spectrum Pharmaceuticals, and Celgene. A.K. declares honoraria from Takeda Pharmaceuticals consulting for, or advisory role with Shire; and received travel, accommodation, and expenses funds from Takeda Pharmaceuticals. J.E.A. declares honoraria from Janssen; and research funding from Appia Pharmaceuticals. C.D. declares stock and other ownership interests in Gilead Sciences; consulting for or advisory role with Seattle Genetics, Bayer HealthCare Pharmaceuticals, Bristol Myers Squibb, Genentech/Roche, and Merck; and research funding from Seattle Genetics (to institution), Genentech (to institution), Incyte (to institution), LAM Therapeutics (to institution), Merck (to institution), Bristol-Myers Squibb (to institution), Millennium Pharmaceuticals (to institution), MEI Pharma (to institution). R.I.F. declares consulting for, or advisory role with Pharmacyclics/Janssen, Roche, Kite Pharma, Seattle Genetics, Sandoz, Celgene, Genentech, Bayer HealthCare Pharmaceuticals, AstraZeneca, Adaptive Biotechnologies, and Ion Solutions; and provided expert testimony for Roche. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
CONSORT diagram.
Figure 2.
Figure 2.
PFS for each group. auto-HCT, autologous hematopoietic cell transplant. elg, eligible; inelig, ineligible.
Figure 3.
Figure 3.
OS for each group.
See this image and copyright information in PMC

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