Time to progression of mantle cell lymphoma after high‐dose cytarabine‐based regimens defines patients risk for death

The current standard treatment of younger patients with mantle cell lymphoma (MCL) includes rituximab and highdose cytarabine (HD-AraC), usually followed by autologous stem cell transplantation (ASCT). This approach has improved the long-term outcome of these patients. However, no plateau in survival curves has been observed, and virtually all patients will experience disease recurrence for which no standard therapy exists (Dreyling et al, 2017). Allogeneic stem cell transplantation (AlloSCT) remains the only option with curative potential (Robinson et al, 2015; Tessoulin et al, 2016; Rule et al, 2017). The data included in the largest report on MCL patients who relapsed after ASCT was obtained between 2000 and 2009, but only 50% of cases had documented exposure to rituximab and HD-AraC before ASCT (Dietrich et al, 2014). Inclusion criteria for this retrospective study of firstrelapsed or -refractory MCL patients from 26 centres associated to the Fondazione Italiana Linfomi (FIL) were: (i) upfront treatment with intensive regimens including rituximab and HD-AraC, defined as cytarabine with a single dose >1 g/m; (ii) MCL diagnosed between 1 January 2007 and 31 June 2016. Upfront regimens were stratified into three categories: high dose sequential therapy followed by ASCT (Geisler et al, 2008; Magni et al, 2009); R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) alternating with R-DHAP (rituximab, dexamethasone, HD-AraC, cisplatin) followed by ASCT (Hermine et al, 2016); R-HyperCVAD/MTXHDAC (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, high-dose methotrexate/cytarabine) followed by