LAUSR

Recent clinical advances in mantle cell lymphoma (MCL) have seen standard-of-care treatment algorithms transformed. Frontline rituximab combination therapy, high dose cytarabine-based induction in younger patients and, more recently, Bruton Tyrosine Kinase (BTK) inhibitors in the relapse setting have all demonstrated survival advantage in clinical trials (Wang et al, 2013; Eskelund et al, 2016; Rule et al, 2016). Over the last 15 years these practices have gradually become embedded in clinical practice and real-world data has observed corresponding improvements in patient survival (Abrahamsson et al, 2014; Leux et al, 2014). In a disease that has seen dramatic shifts in the treatment landscape over a relatively short time-period, this study aimed to establish whether initial diagnosis and treatment at a specialist centre, which would be expected to adopt new approaches sooner, offers an overall survival advantage in comparison to patients treated in other settings. By extension, the study also sought to confirm a survival benefit with current best practice in a real-world setting. Derriford Hospital in Plymouth, UK, specialises in the management of patients with MCL. It provides a national referral service, runs a specialist clinic and has extensive involvement in early-phase clinical trials. The hospital provides secondary care for a local population of approximately 450 000 people. For comparison, data was used from the UK population-based Haematological Malignancy Research Network (HMRN; www.hmrn.org), which covers a catchment population of nearly 4 million people that broadly mirrors the socio-demographic composition of the Plymouth area. Within HMRN patient care is provided by 14 hospitals, including academic centres and district general hospitals. Comprehensive outcome data from HMRN has recently been published (Smith et al, 2018). A retrospective analysis was performed to assess outcome and treatment strategies for all new MCL diagnoses at Derriford Hospital and the HMRN from the years 2004 to 2015. All patients at Derriford were identified from a local database and displayed evidence of t(11:14) or cyclin D1 overexpression. Any patients treated at the hospital following referral from neighbouring centres were excluded to avoid selection bias. Forty-six patients were included from Derriford, and 335 patients from HMRN. Statistical analyses were performed in Stata 14 (StataCorp. LLC, College Station, TX, USA). The median age of the Derriford patients was 71 (range 51–90) years compared to 74 (range 34–96) years in HMRN patients (P = 0 21), 69 6% of patients were male compared to 67 0% [odds ratio (OR): 0 87, 95% confidence interval (CI): 0 45–1 70, P = 0 69], performance score was