A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma

Blood ◽  
2008 ◽  
Vol 111 (2) ◽  
pp. 558-565 ◽  
Author(s):  
Eva Hoster ◽  
Martin Dreyling ◽  
Wolfram Klapper ◽  
Christian Gisselbrecht ◽  
Achiel van Hoof ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Mantle Cell Lymphoma ◽  
Cox Regression ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Rank Test ◽  
Advanced Stage ◽  
Prognostic Relevance ◽  
Mantle Cell

There is no generally established prognostic index for patients with mantle cell lymphoma (MCL), because the International Prognostic Index (IPI) and Follicular Lymphoma International Prognostic Index (FLIPI) have been developed for diffuse large cell and follicular lymphoma patients, respectively. Using data of 455 advanced stage MCL patients treated within 3 clinical trials, we examined the prognostic relevance of IPI and FLIPI and derived a new prognostic index (MCL international prognostic index, MIPI) of overall survival (OS). Statistical methods included Kaplan-Meier estimates and the log-rank test for evaluating IPI and FLIPI and multiple Cox regression for developing the MIPI. IPI and FLIPI showed poor separation of survival curves. According to the MIPI, patients were classified into low risk (44% of patients, median OS not reached), intermediate risk (35%, 51 months), and high risk groups (21%, 29 months), based on the 4 independent prognostic factors: age, performance status, lactate dehydrogenase (LDH), and leukocyte count. Cell proliferation (Ki-67) was exploratively analyzed as an important biologic marker and showed strong additional prognostic relevance. The MIPI is the first prognostic index particularly suited for MCL patients and may serve as an important tool to facilitate risk-adapted treatment decisions in patients with advanced stage MCL.

Application of the mantle international prognostic index (MIPI) to patients with mantle cell lymphoma treated with fludarabine/cyclophosphamide: Results from a UK NCRI Lymphoma Group study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 8555-8555
Author(s):  
S. Rule ◽  
P. Smith ◽  
W. Qian ◽  
J. Gambell ◽  
N. Curtis ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Phase Iii ◽  
Rank Test ◽  
Advanced Stage ◽  
Equal Distribution ◽  
Study Results ◽  
Mantle Cell

8555 Background: Mantle cell lymphoma (MCL) remains an incurable malignancy with conventional chemotherapeutic options with little randomised evidence to help direct therapy. The International Prognostic Index (IPI) for diffuse large cell lymphoma or Follicular Lymphoma International Prognostic Index (FLIPI) showed poor separation of survival curves in MCL patients. A new prognostic index (MIPI) based on age, performance status, lactate dehydrogenase (LDH), and leukocyte count was developed for patients with advanced stage MCL. Data from a randomised phase II NCRI trial designed to assess the effect of adding rituximab to an all oral chemotherapy regimen has been used to validate the MIPI. Methods: Patients with advanced stage, newly diagnosed MCL were randomised to receive either oral fludarabine 40mg/m2 and cyclophosphamide 250mg/m2 daily x 3 repeated every 28 days (FC) or FC with standard dose rituximab (375mg/m2 on day 1 of every cycle) (FCR). Patients could receive up to 8 cycles of treatment but no consolidation therapy was permitted. The primary outcome measures were response rate and the feasibility of a phase III randomised study. Results: 156 patients were randomised. Median age 64 (36–88) with a significant male predominance. With median follow up of 49 months for survivors the five year overall survival (OS) is 39%. 117 patients had complete data for calculating the simplified Mantle International Prognostic Index (MIPI) .There was equal distribution between the 3 risk groups (low risk 35%, intermediate risk 33% and high risk 31%). The median OS (months) for the 3 groups is; low not reached, intermediate 55.7 and high 20.4 (p of log rank test = 0.0048). However there is no difference between the 3 groups with regard to progression free survival (p=0.31). Conclusions: This large study of patients treated with an oral purine analogue combination confirms that the MIPI is predictive for OS. However MIPI does not discriminate for PFS suggesting that those patients with high scores have an inferior response to subsequent therapy post relapse after FC based therapy. No significant financial relationships to disclose.

scholarly journals Clinical characteristics and outcomes of primary versus secondary gastrointestinal mantle cell lymphoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alessia Castellino ◽  
Aung M. Tun ◽  
Yucai Wang ◽  
Thomas M. Habermann ◽  
Rebecca L. King ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
Performance Status ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Local Therapy ◽  
Progression Free Survival ◽  
Cell Transplant ◽  
Multiple Lesions ◽  
Mantle Cell

AbstractPrimary gastrointestinal (GI) mantle cell lymphoma (MCL) is rare and the optimal management is unknown. We reviewed 800 newly diagnosed MCL cases and found 22 primary (2.8%) and 79 (9.9%) secondary GI MCL cases. Age, sex, and performance status were similar between primary and secondary cases. Secondary cases had more elevations in lactate dehydrogenase (28% vs 0%, P = 0.03) and a trend for a higher MCL international prognostic index (P = 0.07). Observation or local therapy was more common for primary GI MCL (29% vs 8%, P < 0.01), and autologous stem-cell transplant was more common for secondary GI MCL (35% vs 14%, P < 0.05). The median follow-up was 85 months. Primary and secondary GI MCL had similar 5-year progression-free survival (PFS) (30% vs 28%, P = 0.59) and overall survival (OS) (65% vs 66%, P = 0.83). The extent of GI involvement in primary GI MCL affected treatment selection but not outcome, with a 5-year PFS of 43% vs 14% vs 31% (P = 0.48) and OS of 57% vs 71% vs 69% (P = 0.54) in cases with single lesion vs multiple lesions in 1 organ vs multiple lesions in ≥2 organs. Less aggressive frontline treatment for primary GI MCL is reasonable. It is unknown whether more aggressive treatment can result in improved outcomes.

Using the primary site as a prognostic tool for nodal mantle cell lymphoma: a SEER-based study

2020 ◽  
Vol 9 (12) ◽  
pp. 861-876
Author(s):  
Mohamed Gomaa Kamel ◽  
Amr Ehab El-Qushayri ◽  
Ahmed Kamal Sayed ◽  
Nguyen Tien Huy
Keyword(s):  
Overall Survival ◽  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Primary Site ◽  
Cancer Specific Survival ◽  
Mantle Cell ◽  
Multiple Regions ◽  
Using Data

Background: Nodal mantle cell lymphoma (NMCL) has a worse survival than extra-nodal mantle cell lymphoma. Materials & methods: A cohort study was conducted to evaluate the primary site role as a mortality predictor using data from 1983 to 2011 from the Surveillance, Epidemiology, and End Results (SEER) database. Results: Most patients had NMCL in multiple regions (71.9%). There was a significantly increased incidence of NMCL cases over years with 83.2% of them occurred between 1998 and 2011. The mean survival was 52.9 months with overall survival/cancer-specific survival rate of 29.2/42.9%, respectively. Lymph nodes of intrathoracic and multiple regions had a worse overall survival while the head, face and neck, intra-abdominal, pelvic, inguinal region and leg as well as multiple regions had worse cancer-specific survival. Conclusion: NMCL primary site can serve as a prognostic factor. We encourage adding it to MCL International Prognostic Index.

scholarly journals Bendamustine and rituximab as induction therapy in both transplant-eligible and -ineligible patients with mantle cell lymphoma

2020 ◽  
Vol 4 (15) ◽  
pp. 3486-3494
Author(s):  
Diego Villa ◽  
Laurie H. Sehn ◽  
Kerry J. Savage ◽  
Cynthia L. Toze ◽  
Kevin Song ◽  
...  
Keyword(s):  
High Risk ◽  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
First Line ◽  
Ki 67 ◽  
Historical Cohort ◽  
Entire Cohort ◽  
Mantle Cell

Abstract Rituximab-containing chemotherapy regimens constitute standard first-line therapy for mantle cell lymphoma (MCL). Since June 2013, 190 patients ≥18 years of age with MCL in British Columbia have been treated with bendamustine and rituximab (BR). The overall response rate to BR was 88% (54% complete response). Of these, 61 of 89 patients (69%) aged ≤65 years received autologous stem cell transplantation and 141 of 190 patients (74%) from the entire cohort received maintenance rituximab. Twenty-three patients (12%) had progressive disease, associated with high risk per the Mantle Cell Lymphoma International Prognostic Index (MIPI), Ki-67 ≥50%, and blastoid/pleomorphic histology. Outcomes were compared with a historical cohort of 248 patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; January 2003 to May 2013). Treatment with BR was associated with significant improvements in progression-free survival (PFS), but not overall survival (OS), compared with R-CHOP in the whole cohort (3-year PFS, 66% BR vs 51% R-CHOP, P = .003; 3-year OS, 73% BR vs 66% R-CHOP, P = .054) and in those &gt;65 years of age (3-year PFS, 56% BR vs 35% R-CHOP, P = .001; 3-year OS, 64% BR vs 55% R-CHOP, P = .063). Outcomes in transplanted patients were not statistically significantly different compared with R-CHOP (3-year PFS, 85% BR vs 76% R-CHOP, P = .135; 3-year OS, 90% BR vs 88% R-CHOP, P = .305), although in multivariate analyses, treatment with BR was associated with improved PFS (hazard ratio, 0.40 [95% confidence interval, 0.17-0.94]; P = .036) but not OS. BR is an effective first-line option for most patients with MCL, however, outcomes are suboptimal for those with high-risk features and further studies integrating novel agents are warranted.

Outcome of Deferred Initial Therapy in Mantle-Cell Lymphoma

2009 ◽  
Vol 27 (8) ◽  
pp. 1209-1213 ◽  
Author(s):  
Peter Martin ◽  
Amy Chadburn ◽  
Paul Christos ◽  
Karen Weil ◽  
Richard R. Furman ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Initial Therapy ◽  
Observation Group ◽  
Watch And Wait ◽  
Time To Treatment ◽  
Social Security Death Index ◽  
Mantle Cell

Purpose Treatment of mantle-cell lymphoma (MCL) is nonstandardized, though patients are commonly treated immediately at diagnosis. Because data on observation, or “watch and wait,” have not been previously reported, we analyzed the outcome of deferred initial therapy. Patients and Methods Inclusion criteria in this retrospective analysis were a diagnosis of MCL between 1997 and 2007 and known date of first treatment. Hospital and research charts were reviewed for prognostic and treatment-related information. Date of death was derived from hospital records and confirmed using an online Social Security death index. Results Of 97 patients with MCL evaluated at Weill Cornell Medical Center, 31 patients (32%) were observed for more than 3 months before initial systemic therapy, with median time to treatment for the observation group of 12 months (range, 4 to 128 months). The observation group (median follow-up, 55 months) had a median age of 58 years (range, 40 to 81 years). Prognostic factors in assessable patients included advanced stage (III/IV) in 75%, elevated lactate dehydrogenase in 25%, and intermediate- or high-risk Mantle Cell International Prognostic Index in 54%. Better performance status and lower-risk standard International Prognostic Index scores were more commonly present in those undergoing observation. Although time to treatment did not predict overall survival in a multivariate analysis, the survival profile of the observation group was statistically superior to that of the early treatment group (not reached v 64 months, P = .004). Conclusion In selected asymptomatic patients with MCL, deferred initial treatment (“watch and wait”) is an acceptable management approach.

Mantle Cell Lymphoma: Prognostic Capacity of the Follicular Lymphoma International Prognostic Index.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1910-1910
Author(s):  
Michael B. Moller ◽  
Niels T. Pedersen ◽  
Bjarne E. Christensen
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Risk Groups ◽  
High Risk Group ◽  
Predictive Capacity ◽  
Mantle Cell

Abstract Background: The International Prognostic Index (IPI) is the most commonly used prognostic model in mantle cell lymphoma. However, the prognostic value of IPI is limited. The recently published Follicular Lymphoma International Prognostic Index (FLIPI) is built on variables (age, stage, lactic dehydrogenase, anemia, and nodal disease) which also are pertinent to mantle cell lymphoma. This study was conducted to evaluate the prognostic value of FLIPI in patients with mantle cell lymphoma. Patients and Methods: A population-based series of 93 patients with mantle cell lymphoma diagnosed in a 7-year period were studied. End points of the study were response to therapy, overall survival, and failure-free survival according to IPI and FLIPI. Results: Applied to the whole series, FLIPI identified 3 risk groups with markedly different outcome with 5-year overall survival rates of 65%, 42%, and 8%, respectively (P < .0001; log-rank 28.13; figure below). Notably, the high-risk group comprised 53% of patients. In contrast, IPI only allocated 16% of cases to the high-risk group and had a lower overall predictive capacity (log-rank 24.8). When both FLIPI and IPI were included in a multivariate analysis, only FLIPI was related to survival. In patients treated with CHOP-based regimens (n = 45) FLIPI also had superior predictive capacity compared to IPI (log-rank, 18.51 versus 11.37), and again only FLIPI retained significance in multivariate analysis. Multivariate analysis of failure-free survival also identified FLIPI, and not IPI, as independently significant. Conclusion: FLIPI is the superior prognostic model as compared to IPI and should be the preferred clinical prognostic index in mantle cell lymphoma. Overall survival according to FLIPI risk groups Overall survival according to FLIPI risk groups

The Mantle Cell Lymphoma International Prognostic Index (MIPI) at Diagnosis Is Associated with Survival of Mantle Cell Lymphoma Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1143-1143 ◽  
Author(s):  
Lihua Pan ◽  
Katherine A Guthrie ◽  
Brian G. Till ◽  
Oliver W. Press ◽  
John M. Pagel ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
Performance Status ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Risk Of Death ◽  
Mantle Cell ◽  
Wbc Count

Abstract Mantle Cell Lymphoma (MCL) exhibits short remission durations and a poor prognosis. To improve on these outcomes, many have advocated the use of high-dose therapy (HDT) and ASCT. The MIPI predicts overall survival (OS) from diagnosis, yet it remains unknown if the MIPI assessed at diagnosis (MIPI-Dx) or prior to transplant (MIPI-Tx) can be used to predict OS from ASCT. To address this question we retrospectively evaluated the association of the MIPI-Dx and MIPI-Tx, and other characteristics with OS following HDT and ASCT in 87 consecutive MCL patients transplanted at our center. Baseline characteristics included: median age at diagnosis=56 years (range, 35–70), median age at transplant=57 years (range, 35 – 70), stage III-IV=97%, median LDH/upper limit of normal (ULN) at diagnosis=0.91 (range, 0.46–5.65), median LDH/ULN at transplant= 0.88 (range, 0.39–3.00), median white blood cell (WBC) count at diagnosis=7.50 x 109 / liter (range, 1.40 – 54.70), mean WBC count at transplant=4.66 x 109 /liter (range, 0.07 – 17.60), median number of prior chemotherapy regimens=2 (range, 1–5). The estimated 5-year OS and PFS for the entire cohort were 56% (95% CI, 39–73%) and 45% (95% CI, 30 – 60%), respectively with a median follow up among surviving patients of 2.0 years (range 0.1 – 10.1 years). The MIPI-Dx was a better predictor of OS (p&lt;0.001) than MIPI-Tx (p=0.09), when evaluated as a continuous variable. Similarly, when stratified as a categorical variable, the MIPI-Dx (p=0.09) was superior to the MIPI-Tx (p=0.34) in estimating survival. When compared to patients with a MIPI-Dx of 0–2, those with a score of 3, 4, and 5–8 at diagnosis had a 3.3 (95% CI 0.3–32, p=0.3), 6.1 (95% CI 0.7–54.8, p=0.11), and 11.1 (95% CI 1.3–92.9, p=0.03) fold higher risk of mortality after transplant, respectively (Figure). We next determined if any pre-transplant factors could improve our ability to predict outcome after ASCT. Multivariable modeling identified pretransplant factors of ECOG PS &gt;0 (hazard ratio (HR) of 3.0, p=0.03), number of prior regimens &gt;2 (HR 5.2, p=0.01), lack of complete remission (CR) (HR 3.4, p=0.04), and elevated LDH (HR 4.4, p=0.01) as associated with higher risk of death after transplant. These results indicate that the MIPI-Dx is a robust prognostic tool that can even be used to predict outcomes after a later transplant, suggesting that it may continue to reflect the biology of an individual patient’s disease over time. Further assessment of survival predictions after ASCT can be made independently by examining pre-transplant factors including performance status, number of prior regimens, attainment of CR, and LDH. Though these data require prospective validation, our results can be used to counsel patients about outcomes and account for potential differences in results from clinical trials of HDT and ASCT for MCL. Figure Figure

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