title: Prognostic model for mantle cell lymphoma in the rituximab era: a nationwide study in Japan.
abstract: Mantle 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 rituximab-containing 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 5·4, 8·3 and 33·0, 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.
authors.affiliation: Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX, USA.|Division of Epidemiology and Prevention, Aichi Cancer Centre Research Institute, Nagoya, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Chihara
authors.affiliation: Department of Pathology and Clinical Laboratories, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Asano
authors.affiliation: Department of Haematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ohmachi
authors.affiliation: Department of Haematology and Cell Therapy, Aichi Cancer Centre Hospital, Nagoya, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kinoshita
authors.affiliation: Department of Haematology and Medical Oncology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: Department of Haematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Haematology Division, Department of Medicine, Hyogo Cancer Centre, Akashi, Japan.
authors.forename: Ishikazu
authors.initials: I
authors.lastname: Mizuno
authors.affiliation: Department of Haematology, Kameda Medical Centre, Kamogawa, Japan.
authors.forename: Kosei
authors.initials: K
authors.lastname: Matsue
authors.affiliation: Department of Haematology and Oncology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Uchida
authors.affiliation: Department of Haematology, National Hospital Organization Nagoya Medical Centre, Nagoya, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nagai
authors.affiliation: Department of Haematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Momoko
authors.initials: M
authors.lastname: Nishikori
authors.affiliation: Department of Pathology and Clinical Laboratories, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Haematology and Laboratory Medicine, Suzuka National Hospital, Suzuka, Japan.
authors.forename: Michinori
authors.initials: M
authors.lastname: Ogura
authors.affiliation: Department of HSCT Data Management and Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001772:Blood Cell Count; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D020522:Lymphoma, Mantle-Cell / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage; D012307:Risk Factors; D000069283:Rituximab; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D012709:Serum Albumin; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase; D011241:Prednisone
keywords: MIPI; mantle cell lymphoma; prognostic factor; rituximab