Background: Mantle cell lymphoma (MCL) is a rare and aggressive subtype of non-Hodgkin lymphoma with a median age at diagnosis of 69. Over the past two decades, several novel agents have been approved to treat MCL. The study evaluated the comparative effectiveness in terms of 1-year survival rates for bendamustine, bortezomib, rituximab, and chemotherapy in elderly patients newly diagnosed with MCL. Methods: All newly diagnosed MCL patients aged 66 or older were identified in SEER-Medicare databases from 1999-2013. Patients were categorized into four groups based on their first-line treatment regimens (chemotherapy alone, rituximab ± chemotherapy, bortezomib ± chemotherapy, and bendamustine ± chemotherapy). Multivariate proportional hazard regressions were performed to compare the all-cause mortality and MCL-specific mortality rates among four treatment groups. Results: A total of 1,338 eligible MCL patients were included (chemotherapy alone group= 192, rituximab group= 919, bortezomib group= 35, and bendamustine group= 192). In the multivariate regressions with 1-year follow-up, rituximab and bendamustine groups showed decreased all-cause mortality rates (Rituximab vs. chemotherapy: hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.35-0.71; Bendamustine vs. chemotherapy: HR 0.59, 95% CI 0.35-1.00) and MCL-specific mortality rates (Rituximab vs. chemotherapy: HR 0.50, 95% CI 0.35-0.72; Bendamustine vs. chemotherapy: HR 0.53, 95% CI 0.30-0.93) compared with chemotherapy alone group. Bortezomib group did not show decreased 1-year mortality rates compared with chemotherapy alone group. When comparing bendamustine with rituximab groups, there was no significant difference in either 1-year all-cause mortality or MCL-specific mortality rates. Conclusions: For elderly patients newly diagnosed with MCL, addition of rituximab and bendamustine as first-line treatment showed significantly improved 1-year survival rates compared with chemotherapy alone, but addition of bortezomib did not improve the 1-year survival rate.