Prognostic model for mantle cell lymphoma in the rituximab era: a nationwide study in Japan

Abstract

SummaryMantle cell lymphoma (MCL) is essentially incurable with conventional chemotherapy. The MCL International Prognostic Index (MIPI) is a validated specific prognostic index, but was derived from patients with advanced-stage disease primarily in the pre-rituximab era. We analysed 501 MCL patients (median age, 67 years; range 22-90) treated with rituximabcontaining chemotherapy, and evaluated the prognostic factors adjusted by the treatment. Five-year overall survival (OS) in the low, intermediate and high MIPI groups was 74%, 70% and 35%, respectively. Additional to MIPI risk factors, multivariate analysis revealed that low serum albumin and bone-marrow involvement were also significantly associated with a poor outcome. The revised-MIPI (R-MIPI) was constructed using six factors, namely age, performance status, white blood cell count, serum lactate dehydrogenase, bone-marrow involvement and serum albumin, which is divided into four prognostic groups. Five-year OS in low, low-intermediate (L-I), high-intermediate (H-I) and high R-MIPI groups was 92%, 75%, 61% and 19%, respectively. Hazard ratio for OS of L-I, H-I and high risk to low risk patients were 5Á4, 8Á3 and 33Á0, respectively. R-MIPI, a new prognostic index with easy application to the general patient population, shows promise for identifying low-and high-risk MCL patients in the rituximab era.

Simplified MIPI-B prognostic stratification method can predict the outcome well—retrospective analysis of clinical characteristics and management of newly-diagnosed mantle cell lymphoma patients from China

“…According to other literatures, factors that could predict the prognosis of MCL patients also included the gender, age, B symptoms, spleen involvement, bone marrow involvement, tumor diameter, peripheral white blood cell count, monocyte count, hemoglobin, β2 microglobulin, and albumin level. [27,31–38] In this study, we also found that B symptoms, monocyte count, serum macroglobulin level, and albumin level had significant effects on the OS of patients. The B symptoms, in particular, turned out to be an independent prognostic factor associated with the PFS and OS of the patients, which was consistent with literature reports.…”

“…Moreover, we found that the MIPI in this study did not have a significant risk stratification function, which was similar to the multi-center and retrospective data from 1 Japanese study. [27] As proposed by Hoster et al, [7] the s-MIPI was more appropriate than the MIPI in the general population in clinical practice.…”

Clinicopathologic consensus study of gray zone lymphoma with features intermediate between DLBCL and classical HL

“…This is a clinical factor that has been shown to be prognostic in HL as well as non-Hodgkin lymphomas. [32][33][34][35][36][37][38] However, the small number of patients and relative heterogeneity of therapy limit conclusions regarding prognostication.…”

R‐High‐CHOP/CHASER/LEED with autologous stem cell transplantation in newly diagnosed mantle cell lymphoma: JCOG0406 STUDY

“…Thus, the high CR rate of 82.2% in the present study is notable. Recently, retrospective data of a nationwide study of MCL in Japan were reported . In that study, 501 patients with newly diagnosed MCL with a median age of 67 (range 22‐90) years treated with rituximab‐containing therapy between 1992 and 2012 were analyzed.…”