The human leukocyte antigen (HLA) system is central to immune function, transplantation compatibility, and disease susceptibility. However, comprehensive data on HLA allele and haplotype distributions in Southeast Asia, particularly Malaysia, remain limited despite the region's rich genetic diversity. In this study we analyzed HLA class I (A, B, C) and class II (DRB1, DQB1) alleles in 4,882 individuals of Malay, Chinese, Indian, and Indigenous descent from genotyping data collected between 2000 and 2020. HLA genotyping was performed using PCR-SSP and PCR-SSO methods. Haplotype frequencies (HF) were resolved using haplotype segregation analysis (HSA) and the expectation-maximization (EM) algorithm, with linkage disequilibrium (LD) and Hardy-Weinberg equilibrium (HWE) evaluated across loci. The most frequent alleles included HLA-A*11, -A*02, -B*15, -B*40, -C*07, -C*03, -DRB1*15, and -DQB1*03, with notable variation among ethnic groups. A total of 1,416 unique A ∼ B ∼ DRB1 ∼ DQB1 haplotypes and 1,317 A∼C∼B∼DRB1∼DQB1 haplotypes were identified, with A*33∼C*03∼B*58∼DRB1*03∼DQB1*02 being the most prevalent overall (4.0 %). Ethnic-specific haplotypes were also delineated, underscoring the population's complex genetic architecture. Principal component analysis demonstrated genetic relatedness between Malaysian groups and other East and South Asian populations. This study represents the largest multiethnic HLA dataset in Malaysia to date. The findings contribute valuable insights for population genetics, donor registry optimization, and future disease association and immunogenomic research in Southeast Asia.

The rising incidence of multiple myeloma (MM) in Malaysia, combined with limited access to newer therapies, highlights the need for locally adapted clinical guidance. This consensus aimed at establishing expert recommendations for the management of MM within Malaysia’s resource-variable healthcare system. A modified Delphi process was conducted with 11 haematologists. To inform evidence-based recommendations, a targeted literature review was performed from January 2012 to June 2025. These recommendations were then evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. A total of 58 consensus statements were developed across various areas, including diagnosis, staging, treatment of newly diagnosed and relapsed/refractory disease, renal impairment, infection prevention, high-risk smouldering myeloma, and supportive care. Agreement was assessed using a three-point Likert scale, with all statements achieving ≥ 80% consensus. Consensus recommendations highlighted that triplet induction remains the minimum standard for transplant-eligible patients in Malaysia. Quadruplet regimens deliver deeper responses and improved survival but are limited by regulatory and cost barriers across Asian health systems. In transplant-ineligible patients, treatment should be individualised based on age, frailty, cytogenetic risk, comorbidities, and financial considerations. Novel cellular and immune-based therapies, including CAR-T cells and bispecific antibodies, offer meaningful benefit in heavily pretreated disease, though availability remains restricted. Infection prophylaxis, immunoglobulin support, vaccination, and proactive management of myeloma-related bone disease are essential components of comprehensive care. Continued efforts to improve access to advanced diagnostics, novel therapies, and clinical trial participation will be critical to further enhance outcomes. This consensus provides a standardised, evidence-based framework to optimise MM care and improve patient outcomes nationally.

The gut microbiome and cytokines are involved in maintaining immune homeostasis and may influence the prognosis and complications experienced by acute leukaemia (AL) patients receiving chemotherapy. This longitudinal study analysed blood and stool samples from AL patients (≥ 18 years, scheduled for intensive chemotherapy) in two groups: no prior exposure to chemotherapy (CNE) and prior chemotherapy exposure (CE). Samples were collected at three time points: pre-chemotherapy (T0), an on-treatment time point (T1), and approximately two weeks post-chemotherapy (T2). The gut microbiome was assessed using 16S rRNA sequencing, while cytokines (IL-5, IL-10, IL-17, TNF-α, IFN-γ, TGF-β) and gut permeability markers (I-FABP and zonulin) were quantified using immunoassays. A total of 33 AL patients (CNE = 21; CE = 12; median age = 51 years) were recruited and analysed. In unadjusted analyses, a significant decrease in gut microbiome alpha diversity was observed at T2 compared to T0 (p < 0.05), consistent with post-chemotherapy dysbiosis. Beta diversity showed no significant differences across time points or subgroups. Numerical increases in genera such as Enterococcus and Escherichia-Shigella were noted at T1. In assessments of gut integrity, a significant decrease in I-FABP (p = 0.023) and zonulin (p = 0.022) were observed at T2 compared to T0. Cytokine profiling revealed no significant changes in TNF-α or IFN-γ. IL-5 levels increased at T1 and T2 (p < 0.05), TGF-β decreased from T0 to T1 (p < 0.05), and IL-17 rose from T0 to T1 in CNE patients (p < 0.05) (all in unadjusted analyses). These findings are consistent with peri-chemotherapy shifts in gut microbiome and plasma cytokine. Confirmation in larger cohorts using repeated-measures analyses with covariate adjustment is warranted before drawing clinical inferences.

PURPOSE:Tyrosine kinase inhibitors (TKIs) have improved the prognosis of chronic myeloid leukaemia (CML), allowing patients with favourable disease profiles and molecular responses to attempt treatment-free remission (TFR). We aim to establish the relapse-free survival (RFS) outcomes and identify prognostic factors for successful remission maintenance among those who attempt TFR. METHODS:Adult CML patients who had undergone TFR from January 1, 2016, to June 30, 2024, were included. Upon TKI discontinuation, real-time quantitative polymerase chain reaction (RQ-PCR) was monitored monthly for the first 12 months, then every 3 months, with TKI reinitiated upon a transcript level above 0.1% (IS). Data analysis was performed using SPSS version 29.0 (SPSS Inc., Chicago, IL, USA). RESULTS:Fifty-seven patients (27 males and 30 females) with a median age of 46 years (range 16 - 70) were analysed. The majority had a low EUTOS long-term survival (ELTS) score (61.4%, n = 35) and received imatinib (87.7%, n = 50). The median treatment duration was 8.8 years (range 4.2 - 18.8), and the median duration for sustained deep molecular remission (DMR) was 4.6 years (range 2.1 - 11.1). RFS was 70.2% at 6 months, 62.5% at 12 months and 56.8% at 2 years after a median follow-up of 34 months (range 9 - 101). The MR5 level was identified as an independent factor associated with sustained remission. All relapsed patients achieved DMR upon treatment reinitiation. CONCLUSION:Treatment discontinuation can be safely performed, with many achieving long-term treatment-free remission. A deeper molecular response (MR5) is associated with an improved likelihood of remission maintenance.

Multiple myeloma (MM) is characterized by the malignant proliferation of plasma cells within the bone marrow. The transcriptional mechanisms governing plasma cell differentiation and MM pathogenesis are regulated by an intricate network of transcription factors, the role of RUNX1 in this process remains poorly defined. This study aimed to characterize plasma cell subsets in MM and evaluate the expression and functional role of RUNX1 during B cell differentiation. Bone marrow and peripheral blood samples were collected from 61 MM patients and 18 healthy donors. Flow cytometry was used to identify B cell and plasma cell subsets and measure RUNX1 expression across B cell maturation stages. Functional validation was conducted via siRNA-mediated RUNX1 knockdown in CD19+ B cells followed by in vitro plasma cell differentiation assays. Our data showed that MM patients exhibited significantly increased proportions of plasma cells in bone marrow compared to healthy controls. Intriguingly, RUNX1 expression was low in naive B cell subsets but increased progressively through plasmablast, pre-plasma, and plasma stages. Although RUNX1 expression did not significantly differ across MM stages or between newly diagnosed and relapsed/refractory cases, plasmablasts from MM patients showed higher RUNX1 levels than those from controls. Knockdown of RUNX1 in vitro using siRNA delayed B cell differentiation transiently. In summary, RUNX1 expression is dynamically upregulated during terminal B cell differentiation and is elevated in MM-derived plasmablasts. These findings provide new insights into a potential role for RUNX1 in the B cell differentiation axis and MM disease progression.

Background:The acceptability and impact of mobile health (mHealth) applications on health outcomes in haemato-oncology remain unclear, particularly for patients undergoing long-term oral systematic anticancer therapy (SACT). Purpose:This systematic review investigated the acceptability and efficacy of mHealth applications in facilitating self-management of oral SACT in patients with haematological malignancies. Methods:We conducted a comprehensive search of five electronic databases, PubMed, PsycINFO, CINAHL, Cochrane Library, and Web of Science, until October 2024, and extracted data, including methodologies, application names, functionalities, and key results. This was followed by a narrative synthesis of quantitative outcomes, and a thematic analysis of qualitative data. Results:Eight studies were included, comprising three qualitative studies, one randomised controlled trial, one non-randomised trial, and three mixed-method studies. mHealth applications for self-managing oral SACT exhibited acceptability, with usability and satisfaction ratings between 60% and 78%. Using the Normalisation Process Theory, four themes influencing acceptability were: (1) coherence - perceived benefits, (2) cognitive participation - barriers from technical issues, (3) collective action - burden from excessive notifications and inadequate support, and (4) reflexive monitoring - integration challenges in daily routine. Despite no major clinical or behavioural improvements, mHealth applications enhanced patient awareness of support, online health knowledge, and reduced daily life impact. Conclusion:Fostering effective self-management of oral SACT in patients with haematological malignancies requires addressing issues such as application glitches, notification fatigue, and integration barriers to optimise these interventions. Future well-designed clinical trials are warranted to validate the impact of these applications on patient outcomes in cancer care.

Background:A major challenge after allogeneic haematopoietic stem cell transplantation for haematologic malignancies is the management of acute graft-versus-host disease (aGVHD), which remains associated with poor prognosis despite therapeutic advancements. We conducted a randomized, double-blinded, placebo-controlled Phase I/II clinical trial to assess the safety and efficacy of umbilical cord-derived mesenchymal stem cells (Cyto-MSC) as an upfront treatment in patients with grade II-IV aGVHD. Methods:In this multicentre trial, 22 grade II-IV aGVHD patients were randomized to receive up to three infusions of Cyto-MSC (n = 14) or placebo (n = 8), alongside standard corticosteroid therapy. The primary endpoints were overall response (OR) at Day 28 and overall survival (OS) at 12 months. The secondary endpoints included correlation between responses at Day 28 with 12-month OS and exploratory analyses of immune cell subsets. Results:No treatment-related adverse events were observed. There were no significant differences between Cyto-MSC and placebo in the OR at Day 28 and 12-month OS. Among patients with severe grade III-IV aGVHD who achieved OR by Day 28, those treated with Cyto-MSC had significantly improved 12-month OS compared to placebo (100% vs 50%, p=0.039). Furthermore, in patients with severe aGVHD and baseline CD4+ TEMRA >35% or CD8+ TEMRA >70%, the survival benefit was pronounced in the Cyto-MSC group (83.3% and 100%, respectively). In contrast, none of the placebo-treated patients with baseline CD4+ TEMRA <35% (p=0.007) or CD8+ TEMRA <70% (p=0.005) survived at 12 months. OS was significantly associated with OR at Day 28 (p<0.001), baseline CD4⁺ TEMRA (p=0.004), and baseline CD8⁺ TEMRA (p=0.004). Conclusion:Patients with severe grade III-IV aGVHD, particularly those who respond early or have elevated baseline CD4+ TEMRA (>35%) or CD8+ TEMRA (>70%) levels, may have an overall survival advantage when treated with Cyto-MSC as an upfront therapy in combination with standard corticosteroids.

PURPOSEThe management of advanced classical Hodgkin lymphoma (cHL) poses a major challenge in Asia, given disparities in health care resources and the variability in health care systems across the region. This article reviews the practice landscape for advanced cHL in East and Southeast Asia (hereafter referred to as Asia), offers detailed perspectives on the challenges faced by treating physicians, and proposes solutions to improve patient outcomes.METHODSAt the Singapore Lymphoma Scientific Symposium 2024, a panel of lymphoma experts from 10 countries/territories across Asia convened to discuss local cHL management practices. Discussions were supplemented by perspectives from an expert from the United States and a review of published literature on HL in Asia in 2014-2024. This article summarizes meeting discussions and reports relevant aspects of Asian practice preferences for advanced cHL.RESULTSIn Asia, cHL management is hindered by the lack of local guidelines and survivorship programs, challenges in diagnosis and staging because of a lack of resources and funding, and limited access to efficacious novel drugs. This is of particular concern in vulnerable patient populations such as the elderly. To uplift the standard of care for patients with cHL locally, greater cross-regional learning and collaboration could be explored to enhance clinical management capabilities, lower the financial barriers to accessing novel drugs and technologies, and support increased research efforts and clinical trial presence in the region.CONCLUSIONAlthough advanced cHL management remains a challenge in Asia because of diverse needs within the region, regional partnerships and initiatives can bridge existing gaps and supplement local efforts to improve outcomes among patients with advanced cHL.

PURPOSEPeripheral T-cell lymphomas (PTCLs) encompass a group of rare and diverse disease entities for which contemporary frontline treatment options are limited. Patient outcomes for PTCL remain poor globally, and disparities in health care resources and health care system variability across East and Southeast Asia (hereafter referred to as Asia) further complicate PTCL management in the region. This article reviews the practice landscape for PTCL in Asia, provides a nuanced perspective on the challenges faced by physicians in the region, and suggests how patient outcomes can be improved.METHODSA panel of lymphoma experts from 10 countries/territories across Asia convened at the Singapore Lymphoma Scientific Symposium 2024 to discuss local PTCL management practices. Discussions were supplemented by perspectives from an expert from the United States and a review of published literature on PTCL in Asia in the past 10 years. Meeting discussions and relevant aspects of Asian PTCL practice preferences are summarized in this article.RESULTSIn Asia, PTCL diagnosis and management are hindered by the lack of available domain experts, limitations in infrastructure support and funding, and substantial challenges in accessing novel drugs; relapsed/refractory PTCL, in particular, remains an area of great clinical unmet need. To improve the standard of care for patients with PTCL, cross-country collaborative efforts will be required to facilitate cross-border knowledge sharing, enhance access to expertise and specialized pathology services, increase local clinical trial presence, and offer educational and research opportunities.CONCLUSIONSignificant challenges remain for PTCL management in Asia. Concerted efforts to enhance diagnostic accuracy, improve access to innovative therapies, and establish robust international partnerships are crucial for achieving better outcomes for patients with PTCL in the region.

Introduction: The CD34+ hematopoietic cell count was used to define cell harvest goals. Successful peripheral blood stem cell transplantation depends on infusion of an appropriate number of HPCs to achieve rapid and durable hematologic recovery. Purpose: In this study, we evaluated the use of the Hematopoietic Progenitor Cell count program on the Sysmex XN-3000 hematology analyzer as an effective parameter for enumerating CD34+ cells. Patients and Methods: Whole blood samples from 144 subjects who are either healthy donors or patients scheduled to undergo peripheral blood stem cell collection were collected and hemopoietic stem cells were quantified using CD34 cell enumeration by flow cytometry and XN-HPC by hematology analyzer. Results: The correlation between the two methods was high (r = 0.766; 95% CI: 0.702-0.818). Passing-Bablok showed an intercept at 3.45 (2.54 to 4.74) with a slope of 0.78 (95% CI 0.69 to 0.89). Residual analysis of this model indicated no significant deviation from linearity (p = 0.360). The receiver operating characteristic curve demonstrated an area under curve to be 0.88 (0.82 to 0.92), with a positive predictive value of 80.3%. The correlation between CD34+ and XN-HPC showed a strong relationship and good agreement with minimal bias. Conclusion: The XN-HPC showed good analytical performance. With the increasing requirements for stem cell transplantation, a technically simple and rapid alternative for stem cell enumeration that is sustainable is highly useful.

I ntroduction We conducted a multinational, multicenter retrospective registry study to evaluate the efficacy of sequential 2L or 3L Bruton Tyrosine Kinase inhibitor (BTKi) therapy following chemotherapy in patients with MCL in the Asia-Pacific region. In addition, we evaluated the prognostic significance of the time to disease progression (POD) following 1L therapy and the attrition rate across each subsequent line of therapy to gain a deeper insight into the real-world outcomes of sequential therapy. Methods Data were collected from newly diagnosed MCL patients between January 2008 and November 2020 from 27 hospitals in Asian countries, including China, Malaysia, Japan, Singapore, South Korea, Taiwan, and Thailand. Interim analysis with 289 patients was previously reported. An updated analysis of 632 patients was performed at the data cutoff date of December 15, 2023. Progression-free survival (PFS) was defined as the time from index line treatment start to the first event (progression, relapse, or death). Overall survival (OS) was defined as the time from index line treatment start to death. PFS2 or PFS3 was defined as the time from 1L start to progression, relapse, or death following 2L or 3L treatment, respectively. Attrition was defined as failure to receive a subsequent line of therapy due to death or despite the progression of MCL in patients alive at the time of the last follow-up. Results The median age was 62 years (range, 26-90), and 475 patients were male (75.2%). Most of the patients had stage 3 or 4 diseases (n = 552, 87.3%). According to the MIPI score, risk was low in 297 (47.3%), intermediate in 142 (22.5%), and high in 134 (21.2%) patients (unknown in 59 [9.3%] patients). The most frequently administered 1L regimen was R-CHOP or R-CHOP-like regimens (n = 266, 42.1%), followed by cytarabine-containing regimens (n = 200, 31.6%; including R-Hyper-CVAD [n = 91], NORDIC regimen [n = 42], and R-CHOP/R-DHAP [n = 36], and bendamustine-rituximab (BR) (n = 57, 9.0%). With a median follow-up duration of 84.5 months, the median PFS was 35.2 months (95% CI 32.3-41.1), and the median OS was 87.8 months (95% CI 75.4-102.0). A total of 316 patients were treated with 2L treatment. The most frequently administered 2L regimen was BTKi (n = 73, 23.1%; ibrutinib [n = 70]), followed by BR (n = 61, 19.3%) and cytarabine-containing regimens (n = 61, 19.3%; ESHAP or DHAP with or without rituximab [n = 37]). The median PFS was 16.8 months (95% CI 14.0-20.5). Patients who experienced disease progression to 1L treatment within 24 months (POD ≤ 24, n = 154) were significantly associated with worse PFS and OS compared with patients with POD > 24 (n = 161), with a median PFS of 7.3 (95% CI 5.8-10.8) vs. 27.4 months (95%CI 23.3-42.8) (P < 0.01) and OS of 23.9 (95%CI 15.7-36.3) vs. 77.9 months (95%CI 52.9-105.4) (P < 0.01), respectively. For those who were treated with 2L BTKi, the median PFS2 was 52.5 months (95% CI 42.5-76.1) compared with 41.3 months (95%CI 34.1-49.4) in those who were treated with non-BTKi (P = 0.130). A total of 169 patients were treated with 3L treatment. The most frequently administered 3L regimen was BTKi (n = 44, 26.0%; ibrutinib [n = 39]), followed by BR (n = 27, 16.0%) and cytarabine-containing regimens (n = 21, 12.4%; ESHAP or DHAP with or without rituximab [n = 11]). The median PFS was 11.6 months (95% CI 9.7-15.8). For those who were treated with BTKi in the 2L (n = 21) or 3L (n = 44) treatment (total 65 patients), the median PFS3 was 68.9 months (95% CI 49.1-77.1) compared with 40.9 months (95%CI 34.6-51.5) in those who were treated with non-BTKi in the 2L and 3L treatment (n = 104) (P = 0.005). The attrition rates were 21.3% (135/632 patients, 126 due to death), 25.3% (80/316 patients, 78 due to death), and 26.8% (45/169 patients, 42 due to death) for 1L, 2L, and 3L treatment, respectively. Conclusion Our study showed that R/R MCL patients in the Asia-Pacific region were mostly treated with BTKis, and the sequential treatment with BTKi in the 2L or 3L demonstrated favorable survival outcomes. Nevertheless, patients with POD < 24 were associated with worse PFS and OS. In addition, the attrition rate increased with each line of therapy, and death was the dominant contributor to attrition across all lines of therapy. These results may indicate that although sequential treatment with a BTKi may provide favorable survival outcomes, the use of more effective treatments in the front-line setting is important for achieving better outcomes for more patients.

The incidence of invasive fungal infection (IFI) is increasing, especially among patients diagnosed with hematological malignancies due to their immunocompromised nature. Other risk factors include advanced age, exposure to immunosuppressants, neutropenia, and catheter use. Some of the most common IFI organisms reported are Candida and Aspergillus species, and other fungal species, including Scedosporium, Trichosporon, Cryptococcus, and Fusarium have also increasingly been reported in the past years. However, the epidemiologic data on IFI among patients with hematological malignancies in Asian countries are lacking. Therefore, we investigated published epidemiologic data on such cases from the past 10 years (2011-2021) and discuss the challenges faced in the diagnosis and management of IFIs in Asia.

Objective: Mucositis is one of the most feared side effects of cancer treatment. Psychometric analysis of a patient self-assessment score, the oral mucositis daily questionnaire in Malay (OMDQ-Mal) and its construct validity by means of confirmatory factor analysis (CFA) is lacking. This research aimed to test the validity and reliability of OMDQ-Mal.Methods: A total of 114 autologous stem-cell transplantation patients aged >= 18 years old at a national hematology center in Malaysia from April 2019 to December 2020 completed OMDQ-Mal concurrently with physician scores. Internal consistency and reproducibility were determined by Cronbach alpha and intraclass correlation coefficient, respectively. Correlations with physician scores were determined by Spearman correlation. Discriminative validity and construct validity were determined by Mann-Whitney U and CFA, respectively.Results: OMDQ-Mal demonstrated high internal consistency (alpha = 0.874). Test-retest reliability between paired days were moderate to excellent (95% CI = 0.676-0.953). Items in OMDQ-Mal had moderate to strong correlations with physician scores (rho = 0.503-0.721). Discriminative validity indicated that the scores of scales were significantly different between participants with severe and mild conditions. Construct validity results of loading factors 0.708-0.952; composite reliability 0.879-0.974; average variant extracted 0.710-0.841; and heterotrait-monotrait ratio 0.528 established the convergent and divergent validity.Conclusions: In conclusion, the OMDQ-Mal, which captured important quality of life responses, demonstrated adequate validity and reliability. This was supported by a two-component model CFA. The strong correlation of OMDQ-Mal with both physician scores indicated its potential as a comprehensive patient-reported outcome measure of mucositis of the entire alimentary tract.

I ntroduction We conducted a multinational, multicenter retrospective registry study to better define the treatment patterns and survival outcomes of newly diagnosed patients with mantle cell lymphoma (MCL) in the Asia-Pacific region. Methods Data were collected from newly diagnosed MCL patients between January 2008 and September 2019 from 27 hospitals in Asian countries, including China, Malaysia, Japan, Singapore, South Korea, Taiwan, and Thailand. The first interim analysis with 191 patients was previously reported. An updated analysis of 381 patients was performed at the data cutoff date of June 20, 2023. Results The median age was 62 years (range, 26-90), and 282 patients were male (74.0%). The majority of the patients had stage 3 or 4 disease (n = 329, 87.1%). Based on the MIPI score, 20.7% (n = 139) were classified as high-risk, while 39.4% (n = 150) were classified as high-risk according to the IPI. The most frequently administered 1 st line regimen was R-CHOP or R-CHOP-like regimens (n = 177, 46.5%), followed by cytarabine-containing regimens (n = 113, 29.7%), including R-Hyper-CVAD (n = 78), and bendamustine-rituximab (n = 27, 6.3%). There was a significant difference in the treatment pattern between young (age < 65, n = 210) versus elderly patients (age ≥ 65, n = 171). A higher proportion of elderly patients received R-CHOP or R-CHOP-like regimens (n = 98, 57.3%) while cytarabine-containing regimens were more frequently administered in young patients (n = 97, 46.2%). The treatment response to 1st line regimens was available in 349 patients. The overall response rate (ORR) and the complete response (CR) rate among these patients were 91.1% and 57.9%, respectively. The response rates (ORR/CR rate) for each regimen were as follows; 91.4%/49.1% for R-CHOP or R-CHOP-like regimens, 93.5%/67.3% for cytarabine-containing regimens, and 96.2%/76.9% for bendamustine-rituximab (BR). With a median follow-up duration of 82.6 months, the median progression-free survival (PFS) was 40.6 months, and the median overall survival (OS) was 86.8 months (Figure). The median PFS was 35.2 months for R-CHOP or R-CHOP-like regimens, 65.8 months for cytarabine-containing regimens, and 57.9 months for BR. The role of upfront ASCT was evaluated in pts who are < 65 years old and achieved at least partial response (PR) to 1 st line treatment (n = 181). No significant differences were observed in baseline characteristics between patients who received upfront ASCT (n = 48) and those who did not (n = 133). There were no significant differences in PFS and OS between the ASCT and non-ASCT groups, with a 5-year PFS rate of 56.3% vs. 48.9% ( P = 0.190) and a 5-year OS rate of 82.1% vs. 76.1% ( P = 0.069), respectively. The role of maintenance treatment was evaluated in patients who achieved PR or better to 1 st line treatment and did not experience disease progression within 3 months after completion of 1 st line treatment (n = 293). A significantly higher proportion of patients in the non-maintenance group (n = 270) was classified as a high-risk group according to the MIPI score compared with those who received rituximab maintenance (n = 23) (20.3% vs. 0.0%, P = 0.043). Rituximab maintenance was associated with significantly better PFS and OS compared with no maintenance group, with a 5-year PFS rate of 67.7% vs. 42.0% ( P = 0.015) and 5-year OS rate of 88.4% vs. 66.7% ( P = 0.008). A total of 192 patients were treated with 2 nd line regimens. The most frequently administered 2 nd line regimen was cytarabine-based chemotherapy (n = 47, 24.5%), followed by ibrutinib (n = 46, 24.0%) and BR (n = 32, 16.7%). The ORR and the CR rate among these patients were 75.5% and 43.4%, respectively. The median 2 nd PFS was 16.8 months. Conclusion Our study demonstrated that the majority of patients with MCL in the Asia-Pacific region were treated with rituximab-based regimens in the contemporary era. However, R-CHOP or R-CHOP-like regimens are still the most commonly used 1 st line treatment. The rate of upfront ASCT and usage of rituximab maintenance was relatively low, and there was no significant difference in survival outcomes according to upfront ASCT. Although rituximab maintenance was associated with improved survival, patients without maintenance treatment had a higher proportion of high-risk patients in the current study. Our contemporary real-world analysis showed improved survival outcomes compared to previous studies.