Background: MCL is an aggressive form of non-Hodgkin’s lymphoma with an incidence of 1 in 200,000 in the United States. Limited evidence exists on real-world tx utilization, costs, and survival outcomes associated with MCL among older pts in the US. This study examined tx patterns and quantified cost and OS in first- (1L), second- (2L), and third-line (3L) settings in SM pts with MCL. Methods: This retrospective cohort study included older pts (age ≥ 66 yrs) with MCL, identified using a SM-linked database from 01/01/2013 to 12/31/2017, and followed for 2 yrs. Pts were eligible if they had ≥ 1L MCL tx with ≥ 6 months (mo) of continuous enrollment before and after MCL diagnosis. Pts with other primary malignancies or stem cell transplantation (SCT) ≤ 6 mo before first diagnosis of MCL were excluded. A tx regimen was defined as combination of all agents ≤ 35 days of tx initiation; rituximab (R) monotherapy initiated ≤ 7 mo after R-containing regimen was considered maintenance. For each tx line, all-cause and MCL-specific health care resource utilization (HCRU) and costs were calculated per pt per year (PPPY) and adjusted to 2021 US dollars. Kaplan‒Meier method for survival analysis was used to estimate OS in 1L, 2L, and 3L settings. Results: This study included 559 pts with newly diagnosed MCL: median (range) age, 75 (66‒94) yrs; male, 59.7%; mean Charlson Comorbidity Index, 1.44; stage IV (45.3%), and poor performance status (12.2%); subsequently, 305 (54.6%) received 2L and 153 (27.4%) received 3L tx. The most common regimens were bendamustine + R (51.7%) in 1L and ibrutinib in 2L (17%) and 3L (15.7%). For 1L, 2L, and 3L, 6.3%, 14.8%, and 8.5% of pts received radiation therapy, and 0.4%, 5.1%, and 8.6% received SCT, respectively. Median time to next treatment from start of previous line was 245, 127, and 222 days for 1L to 2L, 2L to 3L, and 3L to 4L, respectively. Mean (SD) all-cause total (medical + drug) costs were $169,210 ($174,904), $209,092 ($254,229), and $185,718 ($220,495) PPPY. The median OS from MCL diagnosis until end of follow-up was 47.2 mo (95% CI, 40.9‒53.7). The 12-mo survival was 81.1% (95% CI, 77.5%‒84.9%), 71.4% (95% CI, 65.5%‒77.9%), and 69.9% (95% CI, 61.8%‒79.1%) for 1L, 2L, and 3L, respectively. Conclusions: The study results report substantial costs associated with the use of standard care therapies among older pts with MCL. New treatments are needed to improve clinical outcomes, and reduce HCRU and overall healthcare costs in MCL.