Background:

Mantle Cell Lymphoma (MCL) is a rare subtype of B-cell non-Hodgkin lymphoma characterized by heterogeneous clinical behavior and often poor prognosis. Prior studies have highlighted how race and socioeconomic status can impact clinical outcomes in patients with MCL (Blood doi.org/10.1182/blood-2024-212410, Clin Lymphoma Myeloma Leuk PMID: 31029647). MCL frequently presents with advanced-stage disease and may involve extra nodal sites such as bone marrow and gastrointestinal tract. While therapeutic options have expanded to include chemoimmunotherapy, targeted agents, and stem cell transplantation, outcomes remain variable. Emerging evidence suggests that sociodemographic factors—including race, ethnicity, insurance status, and treatment setting—may influence outcomes in MCL, yet data on how these disparities manifest across facility types are limited. This study examines demographic features, treatment facility types, and survival outcomes among patients with MCL, with a focus on the role of academic vs. community care settings. To our knowledge, this represents the largest national cohort study to date evaluating the intersection of sociodemographic factors, facility type, and survival in MCL, leveraging data from the National Cancer Database (NCDB) spanning over 20 years.

Methods:

We conducted a retrospective analysis of patients diagnosed with MCL in the U.S. between 2004 and 2022 using the National Cancer Database. Patients were categorized by facility type: ACPs included academic and research programs (including NCI-designated centers), while CCPs included community, comprehensive community, and integrated network cancer programs. Demographic, clinical, and treatment characteristics were compared across cohorts. Kaplan-Meier and Cox proportional hazards models were used to evaluate overall survival (OS), adjusting for age, race/ethnicity, insurance, Charlson-Deyo comorbidity score, and distance from treating facility.

Results

Among the 40,479 patients, 58% were treated at ACPs and 42% at CCPs. The majority were male (71%) and White (92%). Hispanic patients represented 5.6% of the cohort and were significantly younger (median age 64 vs. 69 for non-Hispanic patients, p<0.001), more likely to be uninsured or on Medicaid (14% vs. 7%, p<0.001), and more frequently resided in lower-income neighborhoods.

Patients treated at ACPs were younger (median age 67 vs. 70 years, p<0.001), had higher rates of private insurance (42% vs. 33.5%) and were more likely to have higher educational attainment. In contrast, patients treated at CCPs were more frequently from rural areas and Medicaid non-expansion states (49% vs. 35%, p<0.001). Patients treated at ACPs also had longer median distance traveled for care (10.5 vs. 6.8 miles, p<0.001), but shorter time to treatment initiation (median 28 vs. 31 days, p=0.014). Charlson-Deyo scores ≥2 were slightly more common at CCPs (9.2% vs. 8.4%, p=0.033).

Treatment receipt was significantly more frequent in ACPs (75% vs. 66%, p<0.001), and patients at academic centers were more likely to receive chemotherapy combined with immunotherapy. The adjusted median OS was significantly longer for patients treated at ACPs (10.2 years) compared to CCPs (8.8 years, p<0.001). Kaplan-Meier–estimated OS at 2, 5, and 10 years was consistently superior in ACPs: 79%, 63%, and 45% vs. 76%, 59%, and 40%, respectively. On multivariable analysis, treatment at an ACP remained independently associated with improved OS (HR 0.87, 95% CI: 0.84–0.91, p<0.001), after adjusting for all demographic, clinical, and socioeconomic covariates.

Conclusions:

This large, national study—the most comprehensive to date in MCL—demonstrates that treatment facility type significantly influences survival outcomes. Patients treated at ACPs experienced superior OS, likely driven by earlier treatment initiation, greater use of chemoimmunotherapy, and improved access to novel agents and clinical trials. Despite treating a more socioeconomically diverse and medically complex population, ACPs consistently achieved better long-term outcomes than CCPs. These findings highlight the essential role of academic centers in delivering high-quality, guideline-concordant lymphoma care and underscore the need to reduce barriers to specialized treatment. Expanding access to academic-level care—whether through referral networks, community-academic partnerships, or telemedicine—may help close survival gaps and improve outcomes for patients with MCL.

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2025
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