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What factors are currently used to determine how aggressive a mantle cell lymphoma is?
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JiaRuanMDPhD (Physician - Oncology - Hematology/Oncology (Verified) ) - 08 / 04 / 2012
Several clinical and pathological parameters have been shown to be useful to determine the clinical aggressiveness of mantle cell lymphoma, although none of them are perfect. A well-known clinical index is called international prognostic index (IPI), which incorporates information about the patient’s age, LDH, stage, extranodal involvement and performance status. IPI was initially developed for patients with aggressive NHL. A score of 4-5 defines high risk, a score of 2-3 defines intermediate risk, while a score of 0-1 goes with low-risk. More recently, a prognostic index called MIPI (mantle cell lymphoma IPI) was developed specifically for patients with mantle cell lymphoma, which provides a weighted score based on patient’s age, performance status, LDH and white blood cell count. High risk is for an MIPI score over 6.2, low risk is for a score less than 5.7, and intermediate risk for a score in between. Patients with low- and intermediate-risk MIPI scores tend to have more slowly growing disease, and tend to do better with treatment, while those high MIPI scores tend to have more symptomatic disease. Some of recent clinical trials have provided evidence for MIPI score as a better predictor of outcome than the IPI score. Another useful parameter to gauge the clinical behavior of MCL is based on a pathologic scoring of growth rate of tumor cells, known as the Ki-67 rate, named after the nuclear protein Ki-67 that is associated with cellular proliferation. Ki-67 has showed high prognostic relevance for overall survival in MCL patients, independent from clinical factors such as IPI or MIPI. The most favorable survival outcome appears to be associated with Ki-67 rate less than 10%.
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