A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma.
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.
Hoster
Eva
E
Department of Internal Medicine III, University of Munich, Germany.
Dreyling
Martin
M
Klapper
Wolfram
W
Gisselbrecht
Christian
C
van Hoof
Achiel
A
Kluin-Nelemans
Hanneke C
HC
Pfreundschuh
Michael
M
Reiser
Marcel
M
Metzner
Bernd
B
Einsele
Hermann
H
Peter
Norma
N
Jung
Wolfram
W
Wörmann
Bernhard
B
Ludwig
Wolf-Dieter
WD
Dührsen
Ulrich
U
Eimermacher
Hartmut
H
Wandt
Hannes
H
Hasford
Joerg
J
Hiddemann
Wolfgang
W
Unterhalt
Michael
M
D000367:Age Factors; D014408:Biomarkers, Tumor / Q000378:metabolism*; D049109:Cell Proliferation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000235:genetics; D007958:Leukocyte Count; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D015996:Survival Rate
D014408:Biomarkers, Tumor; D007770:L-Lactate Dehydrogenase