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While various prognostic features have been proposed, none currently impact therapy selection, particularly in older patients, for whom treatment is primarily dictated by age and comorbidities. Herein, we undertook a comprehensive comparison of clinicopathological features in a cohort of patients 60\u2009years and older, uniformly treated with bendamustine and rituximab, with a median survival of &gt;8\u2009years. The strongest prognostic indicators in this cohort were a high\u2010risk call by a simplified MCL international prognostic index (s\u2010MIPI) (HR: 3.32, 95% CI: 1.65\u20136.68 compared to low risk), a high\u2010risk call by MCL35 (HR: 10.34, 95% CI: 2.37\u201345.20 compared to low risk) and blastoid cytology (HR: 4.21, 95% CR: 1.92\u20139.22 compared to classic). Patients called high risk by both the s\u2010MIPI and MCL35 had the most dismal prognosis (HR: 11.58, 95% CI: 4.10\u201332.72), while those with high risk by either had a moderate but clinically relevant prognosis (HR: 2.95, 95% CI: 1.49\u20135.82). A robust assay to assess proliferation, such as MCL35, along with stringent guidelines for cytological evaluation of MCL, in combination with MIPI, may be a strong path to risk\u2010stratify older MCL patients in future clinical trials.<\/jats:p>","DOI":"10.1111\/bjh.19153","type":"journal-article","created":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T02:00:26Z","timestamp":1698285626000},"page":"160-170","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of clinical parameters and biomarkers in older, untreated mantle cell lymphoma patients receiving <scp>bendamustine\u2013rituximab<\/scp>"],"prefix":"10.1111","volume":"204","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4991-7712","authenticated-orcid":false,"given":"Colleen A.","family":"Ramsower","sequence":"first","affiliation":[{"name":"Department of Research Mayo Clinic  Scottsdale Arizona 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Avan\u00e7ats, ICREA  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Gin\u00e9","sequence":"additional","affiliation":[{"name":"Department of Hematology Hospital Clinic of the University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0456-8085","authenticated-orcid":false,"given":"James R.","family":"Cook","sequence":"additional","affiliation":[{"name":"Pathology and Laboratory Medicine Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8781-3327","authenticated-orcid":false,"given":"Brian","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Hematology and Medical Oncology Cleveland Clinic\u2010Taussig Cancer Institute  Cleveland Ohio 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