New publication in Blood Cancer Journal: long-term survival after EFS24 in mantle cell lymphoma
At a glance
An international study of 3,179 patients from five cohorts on how patients with mantle cell lymphoma fare after reaching event-free survival at 24 months, published open access.
Our colleague Sara Ekberg, PhD, is an author of Long-term survival and cause-specific mortality after event-free survival at 24 months (EFS24) in mantle cell lymphoma: an international multicohort study, published open access in Blood Cancer Journal (2026). The journal has shared the peer-reviewed, accepted version early, ahead of its final version. The study brings together 37 authors and five cohorts from the United States, Canada, Sweden and Denmark; its first author is Yucai Wang of Mayo Clinic.
Event-free survival at 24 months, or EFS24, marks the patients who reach two years from diagnosis without an event, and is used as an early marker of prognosis in lymphoma. The study asks what reaching it means for patients with mantle cell lymphoma in the era of contemporary immunochemotherapy.
It analysed 3,179 patients diagnosed between 2002 and 2020 in five cohorts: the Mayo Clinic/Iowa MER cohort, a US 12-center cohort, BC Cancer, and the Swedish and Danish cohorts. Two treatment eras were defined in each cohort from shifts in first-line immunochemotherapy, and survival after EFS24 was compared with that of the general population of the same age and sex through the standardised mortality ratio (SMR).
In the MER cohort, patients who reached EFS24 in the earlier era had higher mortality than the general population (SMR 2.36, 95% CI 1.74 to 3.14), while in the contemporary era their survival approached that expected (SMR 1.38, 0.90 to 2.02). After EFS24, lymphoma remained the leading cause of death in the earlier era, with five-year lymphoma-related and other mortality of 18% and 8%, but not in the contemporary era (8% and 9%).
The other cohorts showed similar trends. In the contemporary era, survival after EFS24 approached the general population's in the US 12-center cohort (SMR 1.44), and it improved from the earlier to the contemporary era in the BC Cancer (SMR 4.99 to 3.56), Swedish (4.26 to 3.17) and Danish (2.36 to 2.23) cohorts. The authors conclude that reaching EFS24 in mantle cell lymphoma is associated with survival approaching that of the general population, and with declining lymphoma-related mortality, in the era of contemporary immunochemotherapy.
Sara's work on mantle cell lymphoma also includes our paper in the International Journal of Cancer, which used an illness-death model of Swedish register data to show that the timing of progression matters for survival beyond the 24-month cut-off. Studies like these, built on registers and clinical cohorts, are at the centre of our real-world evidence work; get in touch if you would like to talk about one.
We thank our collaborators for their work on this study: Yucai Wang; Melissa C. Larson; Umar Farooq; Karin E. Smedby; Mikkel R. Simonsen; Peter de Nully Brown; Carsten U. Niemann; Eric J. Zhao; Alina S. Gerrie; Jeffrey M. Switchenko; David A. Bond; Veronika Bachanova; Stefan K. Barta; Brian T. Hill; Peter Martin; Alexey V. Danilov; Natalie S. Grover; Reem Karmali; Nilanjan Ghosh; Timothy S. Fenske; Brad S. Kahl; Alexandra Albertsson-Lindblad; Ingrid Glimelius; Ahmed Ludvigsen Al-Mashhadi; Thomas S. Larsen; Kami J. Maddocks; Eric Mou; Jonas Paludo; Grzegorz S. Nowakowski; Thomas M. Habermann; Matthew J. Maurer; Diego Villa; Jonathon B. Cohen; Tarec C. El-Galaly; Mats Jerkeman; and James R. Cerhan.