Mantle Cell Lymphoma: A North Indian Tertiary Care Centre Experience

  • Das, Chandan Krushna (Department of Medical Oncology, IRCH, All India Institute of Medical Science) ;
  • Gogia, Ajay (Department of Medical Oncology, IRCH, All India Institute of Medical Science) ;
  • Kumar, Lalit (Department of Medical Oncology, IRCH, All India Institute of Medical Science) ;
  • Sharma, Atul (Department of Medical Oncology, IRCH, All India Institute of Medical Science) ;
  • Sharma, Mehar Chand (Department of Pathology, All India Institute of Medical Science) ;
  • Mallick, Saumya Ranjan (Department of Pathology, All India Institute of Medical Science)
  • Published : 2016.10.01


Background: Mantle cell lymphoma (MCL) is an aggressive non-Hodgkin's lymphoma, with a pathognomonic chromosomal translocation t (11;14). Prognosis is uniformly dismal but there is a paucity of information on MCL from India. Materials and methods: We retrospectively analysed clinicopathological information on all treated patients with MCL at our centre. STATA 14.0 was used for analysis. Survival was assessed by Kaplan-Meier analysis and the Cox's proportional hazards method. Statistical significance was defined as a P value of < 0.05. Results: Fifty-one patients with MCL were reviewed. The median age at presentation was 57.0 years. Extranodal involvement was seen in 39.0 (74.0%) while bone marrow positivity at presentation was found in 27.0 (54.0%). Initial treatment was chemotherapy with or without rituximab. Patients receiving rituximab-based therapy (n = 24) had 5-year progression-free survival (PFS) of 21.0 (88.0%), compared with 14.0 (61.0%) for those not receiving rituximab (n = 23, P = 0.036). Twenty-three patients were alive with a median follow-up of 20.7 months (range 2.5-89.2). PFS at 1 and 2 years was 51.0% and 27.0%, and overall survival (OS) 78.0% and 72.0%, respectively. Use of more than 2.0 lines of therapy, use of bendamustine-rituximab, and high TLC (>10,000.0/ significantly affected PFS. Conclusions: In our experience, MCL patients from north India have an early age at presentation. When treated with regimens including rituximab results in an improved response rate and PFS. This study provided comprehensive insights into the treatment of MCL in a developing country.


Chemotherapy;mantle-cell lymphoma;non-Hodgkin's lymphoma;bendamustine


  1. Li J-Y, Gaillard F, Moreau A, et al (1999). Detection of Translocation t(11;14)(q13;q32) in Mantle Cell Lymphoma by Fluorescence in Situ Hybridization. Am J Pathol,154,1449-52.
  2. Martin P, Chadburn A, Christos P, et al (2009). Outcome of deferred initial therapy in mantle-cell lymphoma. J Clin Oncol, 27,1209-13.
  3. Mozos A, Royo C, Hartmann E, et al (2009). SOX11 expression is highly specific for mantle cell lymphoma and identifies the cyclin D1-negative subtype. Haematologica, 94, 1555-62.
  4. Naresh KN, Srinivas V, Soman CS (2000). Distribution of various subtypes of non-Hodgkin's lymphoma in India: a study of 2773 lymphomas using R.E.A.L. and WHO Classifications. Ann Oncol, 1, 63-7.
  5. Romaguera JE, Fayad L, Rodriguez MA, et al (2005). High rate of durable remissions after treatment of newly diagnosed aggressive mantle-cell lymphoma with rituximab plus hyper-CVAD alternating with rituximab plus high-dose methotrexate and cytarabine. J Clin Oncol , 23, 7013-23.
  6. Swerdlow SH, Campo E, Pileri SA, et al (2016). The 2016 revision of the World Health Organization (WHO) classification of lymphoid neoplasms. Blood, 1, 569-643.
  7. Howlader N, Noone AM, Krapcho M et al 2015. In SEER Cancer Statistics Review, 1975-2013,Eds Cronin KA National Cancer Institute. Bethesda, MD.
  8. NCCN clinical practice guideline on NHL version 3.2016 [Internet]. [cited 2016b Jul 3]. Available from:
  9. Argatoff LH, Connors JM, Klasa RJ, Horsman DE, Gascoyne RD (1997). Mantle cell lymphoma: a clinicopathologic study of 80 cases. Blood, 89, 2067-78.
  10. de Boer CJ, Schuuring E, Dreef E, et al (1995). Cyclin D1 protein analysis in the diagnosis of mantle cell lymphoma. Blood, 86, 2715-23.
  11. Bosch F, Lopez-Guillermo A, Campo, E et al (1998). Mantle cell lymphoma. Cancer, 82, 567-75.<567::AID-CNCR20>3.0.CO;2-Z
  12. Cheson BD, Pfistner B, Juweid ME, et al (2007). Revised Response Criteria for Malignant Lymphoma. J Clin Oncol, 25, 579-86.
  13. Delarue R, Haioun C, Ribrag V, et al (2013). CHOP and DHAP plus rituximab followed by autologous stem cell transplantation in mantle cell lymphoma: a phase 2 study from the Groupe d'Etude des Lymphomes de l'Adulte. Blood, 121, 48-53.
  14. Dreyling M, Lenz G, Hoster E, et al (2005). Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL Network. Blood, 105, 2677-84.
  15. Geisler CH, Kolstad A, Laurell A, et al (2010). The Mantle Cell Lymphoma International Prognostic Index (MIPI) is superior to the International Prognostic Index (IPI) in predicting survival following intensive first-line immunochemotherapy and autologous stem cell transplantation (ASCT). Blood, 115, 530-3.
  16. Hoster E, Dreyling M, Klapper W, et al (2008). A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma.Blood, 111, 558-65.