Declining MCL Incidence Aligns With Broader Lymphoma Trends, But Survival Disparities Persist

An analysis of mantle cell lymphoma (MCL) incidence trends from 2000 to 2021 has revealed a significant shift in disease patterns, aligning MCL incidence declines with the broader downward trend observed in non-Hodgkin lymphoma (NHL), according to Ruby Arora, MD.

Using data from the Surveillance, Epidemiology, and End Results (SEER) database, investigators examined incidence patterns, survival outcomes, and sociodemographic disparities in MCL. Results presented at the 2025 ASCO Annual Meeting showed a statistically significant decrease in MCL incidence when comparing consecutive 5-year intervals, marking a reversal from previously reported increases in the disease.

The analysis also uncovered a dose-dependent relationship between income and relative survival rate (RSR), with higher income associated with improved outcomes. Persistent survival disparities were also observed among Hispanic and American Indian patients, while encouraging improvements were noted in RSRs for Black and Asian/Pacific Islander patients.

“Right now, we've identified that these disparities exist, but [we don’t] particularly know yet why they exist,” Arora explained.

In an interview with OncLive®, Arora, a resident physician of internal medicine in the Department of Medicine at The University of Illinois College of Medicine in Chicago, emphasized that these findings not only highlight an encouraging decline in MCL incidence but also underscore the ongoing need to address care inequities, noting that future research should include institutional-level studies, which will be essential to identify the root causes of persistent disparities.

OncLive: What prompted this analysis into trends in MCL, and what incidence patterns were you aiming to identify?

Arora: Alongside Nakhle Saba, MD, [of Our Lady of the Lake Cancer institute at LSU Health Sciences Center], we had noticed in the past that the incidence of MCL had been increasing, and in comparison to the overall decrease in non-Hodgkin lymphoma, we wanted to look a little bit more closely to see if that increase was still occurring or if the MCL incidence was starting to follow the overall decreasing incidence of non-Hodgkin lymphoma as a whole.

What was the study design and methodology used to conduct this analysis?

Since MCL is a more rare subtype of non-Hodgkin lymphoma, making up approximately 5% of overall cases, we wanted to make sure we had an appropriate number of patients to look at [in this analysis]. We wanted to look at a big national database like SEER. This was important for us because it was going to allow us to look at a lot of different variables that we wanted to [analyze] and really make better inferences about survival trends and incidence trends, since we could look at such a large number of patients.

What statistical methods were utilized to evaluate the findings in this study?

First, looking at incidence, we looked at one main factor called the annual percent change [APC], and we were able to statistically define that APC by sets of years. We looked at sets of 5 years, and we were able to compare those to see if those [changes in incidence] were statistically significant. This was what allowed us to see that the overall MCL incidence is declining [in a statistically significant [way] when you compare it to 5 years prior. This is actually following the overall decrease in non-Hodgkin lymphoma, which is a downward trend.

This was a new [finding] that was being reported. In the past, it had been reported that MCL incidence was actually increasing, and our data is now reporting that it is actually following the overall NHL trend, which is trending downward.

What other findings did you report in this analysis?

Some of the other factors that we looked at were interesting. Two of the primary things we examined were [the correlation between] income and survival [outcomes]. When looking at income, we actually found a dose-response relationship between income and survival. As income increased, the relative survival rate [RSR] increased as well. This demonstrated a dose-dependent relationship between income and survival for [patients with] MCL.

Another important factor we examined was RSR by race. We found results similar to prior data, showing that some patients—unfortunately, particularly Hispanic patients and American Indian patients—continue to have significantly lower RSRs vs other groups. This has been reported in the past and is likely due to disparities in care that some patient populations face; unfortunately, those disparities are persisting, which is what we observed in our study.

The other interesting finding from this analysis was that when we looked at RSRs for our Black and Asian/Pacific Islander patients, those rates were starting to improve. This is really encouraging because it suggests that some of the disparities in care for Black and Asian/Pacific Islander patients, which persisted in the past, may be starting to decrease based on the data we observed.

What key takeaways from this analysis do you believe are most important for clinicians to apply in their practice?

The first big key takeaway is that the incidence of MCL as a whole is declining, [similar to] the overall [decline in] non-Hodgkin lymphoma incidences. This is really encouraging data that shows us that MCL, like other non-Hodgkin lymphomas, is continuing to trend downward in the United States.

Specifically, the other important factor that is important for clinicians is disparities in care that we're highlighting, specifically for our Hispanic and American Indian patients. These patients make up a smaller group of our MCL population as a whole, so it's important to make sure we're providing these patients with the best care that we can. [They need to] get [treatment] as quickly as possible. [We also need to] make sure we can do further research to figure out why these disparities are still persisting and how we, as clinicians, can address those gaps in care for these particular patients.

How could findings from this analysis inform future research?

Right now, we've identified that these disparities exist, but [we don’t yet know] why they exist. I think that's where smaller institutional studies can come into play, looking specifically at our own populations of patients so we can [identify] more variables to [help explain] exactly why we have these disparities and what we can do to start to close those disparities. Whether that is access to care, timing to treatment, [or] encouraging our patients to be educated more about the importance of getting into treatment early, we can start to look at those more carefully and then hopefully start to close some of those gaps.

Reference

1. Arora R, Saba NS. Trends in mantle cell lymphoma: Updated SEER analysis from 2000 to 2021. J Clin Oncol. 2025;43(suppl 16):e19081. doi:10.1200/jco.2025.43.16_suppl.e19081