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

• Published in: British journal of haematology 2015-09, Vol.170 (5), p.657-668
• Main Authors: Chihara, Dai, Asano, Naoko, Ohmachi, Ken, Kinoshita, Tomohiro, Okamoto, Masataka, Maeda, Yoshinobu, Mizuno, Ishikazu, Matsue, Kosei, Uchida, Toshiki, Nagai, Hirokazu, Nishikori, Momoko, Nakamura, Shigeo, Ogura, Michinori, Suzuki, Ritsuro
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Blood Cell Count; Cyclophosphamide - administration & dosage; Disease-Free Survival; Doxorubicin - administration & dosage; Female; Humans; Japan - epidemiology; L-Lactate Dehydrogenase - blood; Lymphoma, Mantle-Cell - blood; Lymphoma, Mantle-Cell - drug therapy; Lymphoma, Mantle-Cell - mortality; Male; mantle cell lymphoma; Middle Aged; MIPI; Models, Biological; Predictive Value of Tests; Prednisone - administration & dosage; prognostic factor; Risk Factors; rituximab; Serum Albumin - metabolism; Survival Rate; Vincristine - administration & dosage
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.13486

Summary 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.