At the American Society of Clinical Oncology (ASCO) Annual Meeting (May 29-31, 2020), researchers from the North American Mantle Cell Lymphoma (MCL) Consortium offered clinical, biological, and genomic markers that influence the outcome of patients with MCL.
Kai Fu, MD, PhD, University of Nebraska Medical Center, and colleagues retrospectively studied the clinical and pathological features of 307 patients diagnosed with MCL from 23 institutions across North America from January 2000 to December 2012. The median age of the patient sample was 66 years (range, 24 to 106 years).
Researchers noted that approximately 29% of patients presented with B symptoms and 83.7% of patients had extranodal involvement at diagnosis. At a median follow-up of 7.1 years (range, 0.03 to 16.6 years), the 5-year progression-free survival (PFS) and overall survival (OS) was 27.8% and 54.4%, respectively.
After performing a univariate analysis, Dr Fu and colleagues found a variety of factors that were significantly associated with both inferior PFS and OS (P < .05), including older age (at least 60 years), presence of B symptoms, advanced Ann Arbor stage, elevated LDH, low platelets (less than or equal to 100 K/ml), blastoid/pleomorphic cytology, Ki67 proliferation of at least 30%, circulating tumor cells, no transplantation (vs transplantation), and allogeneic (vs autologous) stem cell transplantation.
Additionally, large tumor size (maximum diameter greater than 3 cm), high white blood cell count (greater than 10 x 103/ml), CD5 or CD23 positivity, and a complex karyotype were found to be associated with inferior OS (P < .05). Multivariate Cox regression analysis showed that age (at least 60 years) and high LDH were the two factors with highest predictive value for clinical outcome.
Importantly, researchers developed a robust prognostic scoring system (MIPI-P) using available clinical and pathological variables. The system gave one point for age at least 60 years, high LDH, Ki67 index of at least 30%, Ann Arbor stage III/IV, and cytological type (blastoid/pleomorphic). MIPI-P stratified 104 MCL cases into low grade (0-1 points), intermediate grade (2-3 points), and high grade (4-5 points). Median survival for the groups was 11.8 years, 4.9 years, and 1.6 years, respectively.
The system was further validated in an independent cohort of 33 MCL cases; MIPI-P reportedly provided robust prognostic prediction (P = .014).
“The modified MIPI scoring system exhibits high efficacy in predicting the prognosis of patients with MCL,” authors of the study concluded.—Zachary Bessette
