New model further stratifies risk in mantle cell lymphoma
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The North American Mantle Cell Consortium stratified nearly 600 patients with mantle cell lymphoma to offer characteristics and risk factors for stratification, according to one presenter at ASCO20 Virtual Scientific Program.
“In this preliminary report from North American Mantle Cell Consortium, using univariate analysis, we identify multiple risk factors, which correlate with overall survival in mantle cell patients. In addition, we identified some factors may have distinct predictive value in the young vs. older patient cohort,” Kai Fu, MD, PhD, a hematopathologist from the University of Nebraska Medical Center.
The consortium looked at 589 patients with mantle cell lymphoma from 23 institutions. The male-to-female ratio was 3.6 to 1, Fu said, and 28% of patients presented at stage 3 or 4. Extranodal involvement was seen in 72% of patients and the median follow-up was 5.2 years. Five-year progression-free survival and overall survival were at 24% and then 60%, respectively.
The researchers conducted multiple univariate analyses, identifying multiple risk factors that correlate with overall survival and then further separated the cohort by age. Fu noted that some risk factors were associated with older or younger patients rather than the entire cohort.
Fu showed the following parameters were significantly associated with all patients and both age groups: B symptoms, ECOG performance status, circulating lymphoma cells, largest tumor size greater than 2 cm, LDH, beta-MG, anemia and thrombocytopenia. Multinodal sites, cytomorphology and Ki67, though, were only associated with the whole cohort and the younger age group.
“We found [mantle cell lymphoma international prognostic index (MIPI)] and MIPI-c both works very well. Then we separated the patients into young and older patient cohorts. However, the MIPI and the MIPI-c works well in the younger patients, but it fails to stratify patients in the older patient group,” Fu said.
Fu introduced the MIPI-P as a “new, simplified scoring system.”
“P stands for pathology, which includes Ann Arbor stage, LDH, cytology, and Ki67. Each accounts for 1 point. So, we separate the patients into three risk groups — low, 0.0; intermediate, 1 to 2; and the high-risk group, 3 through 4,” Fu said.
The researchers showed the efficacy of MIPI-P throughout the entire cohort (P = .000058) as well as in both younger (P = .00093) and older cohorts (P = .07). Fu attributed the lesser significance in the older cohort to the size.
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Fu K, et al. Abstract 8035. Presented at: ASCO20 Virtual Scientific Program; May 29-31, 2020.
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