Optimal Therapeutic Management of Mantle Cell Lymphoma - Episode 3

Risk Assessment and Prognosis in MCL


Brad S. Kahl, MD: We have some ability to prognosticate for a newly diagnosed mantle cell lymphoma patient based upon risk factors. It’s mainly made up of clinical risk factors, so there is something called the MIPI, which is the Mantle Cell International Prognostic Index, and it measures 4 factors: age, performance status, white blood cell count, and LDH or lactate dehydrogenase level. And so, a score can be created for each patient based upon those 4 factors, and you can estimate prognosis based upon whether a patient is low-risk, intermediate-risk, or high-risk. It’s a complicated formula to use and it actually requires an online tool, but if you have the app or you have it on your computer at work, it’s pretty easy to apply. There’s a newer index called the MIPI-C that also incorporates the Ki-67 index, which is an immunohistochemical stain applied to diagnostic tissue. It’s a measure of cell proliferation, and when you combine the MIPI with the Ki-67, you can refine the prognosis even beyond what the simple MIPI can do.

John P. Leonard, MD: The prognosis of patients with low-, intermediate-, and high-risk disease in mantle cell lymphoma is really evolving, I think. The fact of the matter is that there are studies of lower risk patients who tend to be treated in one way or another and high-risk patients who tend to be treated in other ways. When you look at the MIPI, about one-third of patients fall into low-risk disease, one-third in intermediate-risk, and one-third in high-risk disease. When one looks at outcomes, it turns out that most low-risk patients are younger and fitter. Those are features that are associated with a low-risk classification, and, in those situations, patients are often treated more aggressively. Whereas higher-risk patients often are older and have impaired performance status, and those can be treated less aggressively. So, the outcomes really vary in part because of the prognostic scores and perhaps in part in relation to the treatments that those patients receive. That being said, the higher-risk patients have outcomes on the order of overall survivals in the range of 3 to 4 years, whereas low-risk patients can go out over 7 or 8 years in their disease status.

Brad S. Kahl, MD: Biologic prognostic markers in mantle cell lymphoma include things like SOX11 which if patients are SOX11-negative, that tends to travel with a more indolent version of the disease and a better prognosis. P53 mutations is associated with a worse prognosis in mantle cell lymphoma. A complex karyotype is associated with a worse prognosis in mantle cell lymphoma. So, those are the main biologic molecular features that we can use in clinical practice right now to help estimate prognosis.

We can also measure the Ki-67 index just by simple immunohistochemistry. Anyway, using all of those markers, you can refine an individual patient’s prognosis along with the clinical risk factors that we already discussed.

Transcript Edited for Clarity