Evaluating Prognostic Factors for Mantle Cell Lymphoma

Jia Ruan, MD, PhD, Weill Cornell Medicine, New York, New York, discusses important factors to consider in determining the prognosis of mantle cell lymphoma (MCL), including the value of measurement tools such as the Mantle Cell Lymphoma International Prognostic Index (MIPI) and genetic mutation profile data. 

Transcript:

Hi, this is Dr. Jia Ruan. I'm a lymphoma physician at Weill Cornell. I specialize in treating patients with all kinds of lymphoma, and I do a lot of research in a subtype of lymphoma called mantle cell lymphoma.

Oncology Learning Network: What do you consider when measuring potential risk factors for the development of mantle cell lymphoma?

I think you raised a very important question in terms of how we rate the risk factors, which we call prognosis, for patients with mantle cell lymphoma. There's a variety of factors to consider. 

One of the classic ones is called MIPI, Mantle Cell Lymphoma International Prognostic Index. It utilizes 4 very simple clinical parameters—a patient's age, performance status, [lactate dehydrogenase] (LDH) level, and white blood cell counts. We know that those patients with high-risk MIPI scores, historically, would have less survival and perhaps more resistance to chemotherapy-based treatment.

Additionally, we have now more genetic mutation profile data on patients with mantle cell lymphoma, and some of those mutations really have emerged as important prognostic indicators. I want to give examples such as [the] [tumor protein P53] (TP53) mutation. In particular, those patients with TP53 mutations historically looking at the data treated with chemoimmunotherapy, tend to have less of a response or shorter duration. 

So, the question is, what are the best initial therapy options to offer to those patients? Could it be continued chemotherapy, perhaps in combination with an oral agent of a novel target, or novel target combination to start with? I don't think we have answers [to] those questions yet, and therefore it's really important for our patients and providers to consider clinical trials for participation.

Source: 

Yamshon S, Chen G, Gribbin C, et al. Nine-year follow-up of lenalidomide plus rituximab as initial treatment for mantle cell lymphoma. Published online: September 8, 2023. Blood Adv. doi:10.1182/bloodadvances.2023010606