{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T03:28:22Z","timestamp":1772940502689,"version":"3.50.1"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T00:00:00Z","timestamp":1620345600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Mantle cell lymphoma (MCL) presenting in elderly, unfit patients represents a clinical challenge. Front\u2010line \u2018attenuated\u2019 or low\u2010intensity immunochemotherapy is often employed, although outcomes are relatively unexplored. We report outcomes of attenuated immunochemotherapy in 95 patients with MCL across 19 centres in the UK and Ireland considered unfit for full\u2010dose rituximab\u2010bendamustine or rituximab\u2010cyclophosphamide, doxorubicin, vincristine, prednisolone (R\u2010CHOP). Regimens examined were rituximab\u2010cyclophosphamide, vincristine, prednisolone (R\u2010CVP) (<jats:italic>n<\/jats:italic>\u00a0=\u00a019), dose\u2010attenuated R\u2010CHOP (<jats:italic>n<\/jats:italic>\u00a0=\u00a022), dose attenuated rituximab\u2010bendamustine (<jats:italic>n<\/jats:italic>\u00a0=\u00a024) and rituximab\u2010chlorambucil (<jats:italic>n<\/jats:italic>\u00a0=\u00a030). The primary outcome was progression\u2010free survival (PFS). The secondary outcomes included overall response, overall survival (OS) and toxicity. The median (range) age was 79 (58\u201389)\u00a0years and 50% were aged \u226580\u00a0years. The median (range) Cumulative Illness Rating Scale\u2010Geriatric score was 6 (0\u201324). The median PFS for all patients was 15\u00a0months [95% confidence interval (CI) 8\u00b77\u201321\u00b72) and median OS was 31\u00b74\u00a0months (95% CI 19\u00b77\u201343\u00b72). By multivariable analysis (MVA), the only clinical factor associated with an inferior PFS was blastoid morphology [hazard ratio (HR) 2\u00b790, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b701). Notably, higher treatment intensity (R\u2010CHOP\/R\u2010bendamustine composite) provided an independently superior PFS compared with R\u2010CVP\/R\u2010chlorambucil (MVA HR 0\u00b749, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b702). Factors associated with inferior OS by MVA were Eastern Cooperative Oncology Group Performance Status (HR 2\u00b714, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b704), blastoid morphology (HR 4\u00b708, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b7001) and progression of disease at &lt;24\u00a0months status (HR 5\u00b768, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00\u00b7001). Overall, survival after front\u2010line dose\u2010attenuated immunochemotherapy is unsatisfactory. Clinical trials investigating novel agents such as Bruton tyrosine kinase and B\u2010cell lymphoma 2 inhibitors in this specific clinical setting are warranted.<\/jats:p>","DOI":"10.1111\/bjh.17513","type":"journal-article","created":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T18:40:05Z","timestamp":1620499205000},"page":"365-377","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Treatment patterns and outcomes of unfit and elderly patients with Mantle cell lymphoma unfit for standard immunochemotherapy: A UK and Ireland analysis"],"prefix":"10.1111","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2681-5860","authenticated-orcid":false,"given":"Alexandros","family":"Rampotas","sequence":"first","affiliation":[{"name":"Department of Haematology Oxford University Hospital NHS Foundation Trust Oxford UK"},{"name":"Oxford University Graduate Academic School Oxford 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highly selective, non\u2010covalent BTK inhibitor in previously treated mantle cell lymphoma, Waldenstr\u00f6m's macroglobulinemia, and other non\u2010Hodgkin lymphomas: results from the Phase 1\/2 BRUIN study","volume":"136","author":"Wang M","year":"2020","journal-title":"Blood"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00224-5"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.70.4320"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2018.198812"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16271"},{"key":"e_1_2_8_35_1","unstructured":"YamshonS MartinP ShahB SchusterSJ ChristosPJ RodriguezA et al.Initial treatment with lenalidomide plus rituximab for mantle cell lymphoma (MCL): 7\u2010year analysis from a multi\u2010center phase II study. 62nd ASH Annual Meeting and Exposition. 2020;Oral and Poster Abstracts. Abstract 704. Available at:https:\/\/ash.confex.com\/ash\/2020\/webprogram\/Paper138731.html. 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