Clinicopathological profile and prognostic subgrouping of mantle cell lymphomas: A six-year retrospective study from a tertiary care center in Kerala

Abstract

Mantle cell lymphoma (MCL) is a rare mature B-cell non-Hodgkin lymphoma that is known to exhibit heterogeneous biological behavior and variable clinical outcomes. Ki-67 proliferation index, blastoid morphology, and p53 expression are important prognostic markers. The primary objective was to analyze the clinicopathological spectrum of MCL cases diagnosed over 6 years at Amrita Institute of Medical Sciences, Kerala, India. The secondary objectives were to evaluate the prognostic significance of Ki-67 index and p53 immunohistochemical expression in MCL and to compare the clinicopathological features of classic and blastoid variants. This retrospective descriptive study included 21 histopathologically and immunohistochemically confirmed MCL cases diagnosed between January 2019 and December 2024. Clinical, morphological, immunophenotypic, treatment, and follow-up data were analyzed. Ki-67 was assessed in all cases, whereas p53 immunohistochemistry was performed in cases with Ki-67 >30%. Survival was estimated using Kaplan–Meier analysis and compared using the log-rank test. Associations were assessed using Chi-square or Fisher’s exact tests. Fourteen patients were male and seven were female, with a mean age of 67.9 years, (standard deviation: 9.1), a median age of 70 years (interquartile range [IQR]: 60–76 years; range: 50–84 years). Classical MCL constituted 76.2% ( n = 16) of cases, while 23.8% ( n = 5) showed blastoid morphology. Advanced-stage disease was present in 57.1% ( n = 12) of patients. Ki-67 >30%, blastoid morphology, and p53 overexpression were associated with shorter progression-free survival. In MCL, aggressive disease and poorer survival outcomes were associated with blastoid morphology, high Ki-67, and p53 overexpression.