Blood, 15 January 2008, Vol. 111, No. 2, pp. 558-565.
Prepublished online as a Blood First Edition Paper on October 25, 2007; DOI 10.1182/blood-2007-06-095331.
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CLINICAL TRIALS AND OBSERVATIONS
A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma
Eva Hoster1,2,
Martin Dreyling1,
Wolfram Klapper3,
Christian Gisselbrecht4,
Achiel van Hoof5,
Hanneke C. Kluin-Nelemans6,
Michael Pfreundschuh7,
Marcel Reiser8,
Bernd Metzner9,
Hermann Einsele10,
Norma Peter11,
Wolfram Jung12,
Bernhard Wörmann13,
Wolf-Dieter Ludwig14,
Ulrich Dührsen15,
Hartmut Eimermacher16,
Hannes Wandt17,
Joerg Hasford2,
Wolfgang Hiddemann1,
Michael Unterhalt1, for the German Low Grade Lymphoma Study Group (GLSG) and the European Mantle Cell Lymphoma Network
1 Department of Internal Medicine III, and
2 Department of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, Germany;
3 Institute of Pathology, Lymph Node Registry, University of Kiel, Kiel, Germany;
4 Department of Hematology, Hôpital Saint Louis, Paris, France;
5 Department of Hematology, Akademisch Ziekenhuis St-Jan, Bruges, Belgium;
6 Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands;
7 Department of Internal Medicine I, Saarland University Medical School, Homburg, Germany;
8 Department of Internal Medicine I, University of Cologne, Cologne, Germany;
9 Department of Oncology and Hematology, Klinikum Oldenburg, Oldenburg, Germany;
10 Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany;
11 Department of Hematology/Oncology, Carl-Thiem Hospital, Cottbus, Germany;
12 Department of Hematology and Oncology, University of Göttingen, Göttingen, Germany;
13 Städtisches Klinikum Braunschweig, Braunschweig, Germany;
14 Department of Hematology and Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany;
15 Department of Hematology, University Hospital Essen, Essen, Germany;
16 Department of Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany; and
17 Medical Department 5, Klinikum Nürmberg Nord, Nuremberg, Germany
There is no generally established prognostic index for patients with mantle cell lymphoma (MCL), because the International Prognostic Index (IPI) and Follicular Lymphoma International Prognostic Index (FLIPI) have been developed for diffuse large cell and follicular lymphoma patients, respectively. Using data of 455 advanced stage MCL patients treated within 3 clinical trials, we examined the prognostic relevance of IPI and FLIPI and derived a new prognostic index (MCL international prognostic index, MIPI) of overall survival (OS). Statistical methods included Kaplan-Meier estimates and the log-rank test for evaluating IPI and FLIPI and multiple Cox regression for developing the MIPI. IPI and FLIPI showed poor separation of survival curves. According to the MIPI, patients were classified into low risk (44% of patients, median OS not reached), intermediate risk (35%, 51 months), and high risk groups (21%, 29 months), based on the 4 independent prognostic factors: age, performance status, lactate dehydrogenase (LDH), and leukocyte count. Cell proliferation (Ki-67) was exploratively analyzed as an important biologic marker and showed strong additional prognostic relevance. The MIPI is the first prognostic index particularly suited for MCL patients and may serve as an important tool to facilitate risk-adapted treatment decisions in patients with advanced stage MCL.
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O. Determann, E. Hoster, G. Ott, H. Wolfram Bernd, C. Loddenkemper, M. Leo Hansmann, T. E. F. Barth, M. Unterhalt, W. Hiddemann, M. Dreyling, et al.
Ki-67 predicts outcome in advanced-stage mantle cell lymphoma patients treated with anti-CD20 immunochemotherapy: results from randomized trials of the European MCL Network and the German Low Grade Lymphoma Study Group
Blood,
February 15, 2008;
111(4):
2385 - 2387.
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