{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T20:40:00Z","timestamp":1783629600657,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Mantle cell lymphoma (MCL) is a rare malignancy with heterogeneous behavior. Despite the therapeutic advances recently achieved, MCL remains incurable. Currently, the standard of care for young and fit patients involves induction immunochemotherapy followed by up-front autologous stem cell transplantation (ASCT). However, the role of more intensive induction regimens, such as those based on high doses of cytarabine (HDAC), remains controversial in the management of ASCT-eligible patients. Methods: This retrospective, observational, and single-center study involved 165 MCL patients treated at the largest oncology center in Latin America from 2010 to 2022. We aimed to assess outcomes, determine survival predictors, and compare responses between different primary therapeutic strategies, with a focus on assessing the impact of HDAC-based regimens on outcomes in ASCT-eligible patients. Results: The median age at diagnosis was 65 years (38\u201389 years), and 73.9% were male. More than 90% of the cases had a classic nodal form (cnMCL), 76.4% had BM infiltration, and 56.4% presented splenomegaly. Bulky \u2265 7 cm, B-symptoms, ECOG \u2265 2, and advanced-stage III\/IV were observed in 32.7%, 64.8%, 32.1%, and 95.8%, respectively. Sixty-four percent of patients were categorized as having high-risk MIPI. With a median follow-up of 71.1 months, the estimated 2-year OS and EFS were 64.1% and 31.8%, respectively. Patients treated with (R)-HDAC-based regimens had a higher ORR (85.9% vs. 65.7%, p = 0.007) compared to those receiving (R)-CHOP, as well as lower POD-24 rates (61.9% vs. 80.4%, p = 0.043) and lower mortality (43.9% vs. 68.6%, p = 0.004). However, intensified induction regimens with (R)-HDAC were not associated with a real OS benefit in MCL patients undergoing up-front consolidation with ASCT (2-year OS: 88.7% vs. 78.8%, p = 0.289). Up-front ASCT was independently associated with increased OS (p &lt; 0.001), EFS (p = 0.005), and lower POD-24 rates (p &lt; 0.001) in MCL. Additionally, CNS infiltration, TLS, hypoalbuminemia, and the absence of remission after induction were predictors of poor OS. Conclusions: In the largest Latin American cohort of MCL patients, we confirmed the OS benefit promoted by up-front consolidation with ASCT in young and fit patients, regardless of the intensity of the immunochemotherapy regimen used in the pre-ASCT induction. Although HDAC-based regimens were not associated with an unequivocal increase in OS for ASCT-eligible patients, it was associated with higher ORR and lower rates of early relapses for the whole cohort.<\/jats:p>","DOI":"10.3390\/cancers15194759","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T01:51:14Z","timestamp":1695865874000},"page":"4759","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Up-Front ASCT Overcomes the Survival Benefit Provided by HDAC-Based Induction Regimens in Mantle Cell Lymphoma: Data from a Real-Life and Long-Term Cohort"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9228-3276","authenticated-orcid":false,"given":"Lu\u00eds Alberto","family":"de P\u00e1dua Covas Lage","sequence":"first","affiliation":[{"name":"Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"},{"name":"Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcela do Vale","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cadiele Oliana","family":"Reichert","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"},{"name":"Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hebert Fabr\u00edcio","family":"Culler","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"},{"name":"Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-7843","authenticated-orcid":false,"given":"F\u00e1bio Alessandro","family":"de Freitas","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"},{"name":"Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"de Oliveira Costa","sequence":"additional","affiliation":[{"name":"Department of Hematology and Hemotherapy, Faculty of Medical Sciences of Santos (FCMS), Santos 01238-010, SP, Brazil"},{"name":"Hospital Alem\u00e3o Osvaldo Cruz (HAOC), S\u00e3o Paulo 01323-020, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0094-619X","authenticated-orcid":false,"given":"Vanderson","family":"Rocha","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"},{"name":"Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"},{"name":"Funda\u00e7\u00e3o Pr\u00f3-Sangue, Blood Bank of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, SP, Brazil"},{"name":"Department of Hematology, Churchill Hospital, Oxford University, Oxford OX3 7LE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila Aparecida Coelho","family":"da Siqueira","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0655-2821","authenticated-orcid":false,"given":"Juliana","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"},{"name":"Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-080, SP, Brazil"},{"name":"Hospital Alem\u00e3o Osvaldo Cruz (HAOC), S\u00e3o Paulo 01323-020, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1182\/blood-2016-01-643569","article-title":"The 2016 revision of the World Health Organization classification of lymphoid neoplasms","volume":"127","author":"Swerdlow","year":"2016","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1038\/s41375-022-01620-2","article-title":"The 5th Edition of the World Health Organization Classification of Haematolymphoid Tumors: Lymphoid 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Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/19\/4759\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:00:14Z","timestamp":1760130014000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/19\/4759"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,28]]},"references-count":41,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["cancers15194759"],"URL":"https:\/\/doi.org\/10.3390\/cancers15194759","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,28]]}}}