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      Clinical features and treatment outcomes in patients with mantle cell lymphoma in Korea: Study by the Consortium for Improving Survival of Lymphoma

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          Abstract

          Background

          We investigated the clinical features and treatment outcomes of patients with mantle cell lymphoma (MCL) in Korea.

          Methods

          We retrospectively analyzed the clinical characteristics and prognosis of 131 patients diagnosed with MCL between January 2004 and December 2009 at 15 medical centers in Korea; all patients received at least 1 chemotherapeutic regimen for MCL.

          Results

          The median age for the patients was 63 years (range, 26-78 years), and 77.9% were men. A total of 105 patients (80.1%) had stage III or IV MCL at diagnosis. Fifty-two patients (39.7%) were categorized with high- or high-intermediate risk MCL according to the International Prognostic Index (IPI). Eighteen patients (13.7%) were in the high-risk group according to the simplified MCL-IPI (MIPI). The overall incidence of extranodal involvement was 69.5%. The overall incidence of bone marrow and gastrointestinal involvements at diagnosis was 41.2% and 35.1%, respectively. Cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab were used frequently as the first-line treatment (41.2%). With a median follow-up duration of 20.0 months (range, 0.2-77.0 months), the overall survival (OS) at 2 years was 64.7%, while the event-free survival (EFS) was 39.7%. Multivariate analysis showed that the simplified MIPI was significantly associated with OS. However, the use of a rituximab-containing regimen was not associated with OS and EFS.

          Conclusion

          Similar to results from Western countries, the current study found that simplified MIPI was an important prognostic factor in Korean patients with MCL.

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          Most cited references28

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          A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma.

          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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            WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview.

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              Improvement of overall survival in advanced stage mantle cell lymphoma.

              Mantle cell lymphomas (MCLs) represent a clinically aggressive lymphoma subtype with a poor prognosis. To explore a potential progress in outcome a historical comparison was performed using data from the Kiel Lymphoma Study Group (KLSG; 1975 to 1986) and the German Low Grade Lymphoma Study Group (GLSG; 1996 to 2004). All patients with the histologically confirmed diagnosis of advanced-stage nonblastoid MCL were eligible. To minimize the potential heterogeneity of different risk profiles frequency matching was pursued. In addition, we adjusted for potential confounding variables by multiple Cox regression. A total of 520 patients were assessable, 150 from KLSG and 370 from GLSG studies. The median overall survival was 2.7 years for KLSG patients as compared with 4.8 years for GLSG patients (P < .0001). The 5-year survival rates were 22% in the KLSG group (95% CI, 13% to 31%) as compared with 47% for GLSG treated patients (95% CI, 38% to 55%). The hazard ratio adjusted for performance status, lactate dehydrogenase, and age was 0.44 for GLSG patients (95% CI, 0.32 to 0.59). Median overall survival of patients with advanced nonblastoid MCL almost doubled during the past 30 years. Potential reasons for this apparent improvement in overall survival include the application of anthracycline-containing regimens and new approaches, such as antilymphoma antibodies or stem cell transplantation. Advances in general supportive care, new diagnostic tools, and general improvement of life span might have also reinforced this effect. However, our results are questioning the validity of historical comparisons which had been frequently applied in previous trials.
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                Author and article information

                Journal
                Blood Res
                Blood Res
                BR
                Blood research
                Korean Society of Hematology; Korean Society of Blood and Marrow Transplantation; Korean Society of Pediatric Hematology-Oncology; Korean Society on Thrombosis and Hemostasis
                2287-979X
                2288-0011
                March 2014
                24 March 2014
                : 49
                : 1
                : 15-21
                Affiliations
                [1 ]Department of Hematology/Oncology, Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
                [2 ]Department of Hematology/Oncology, Internal Medicine, Samsung Medical Center, Seoul, Korea.
                [3 ]Department of Hematology/Oncology, Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.
                [4 ]Department of Hematology/Oncology, Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
                [5 ]Department of Hematology/Oncology, Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
                [6 ]Department of Hematology/Oncology, Internal Medicine, Kosin University Gospel Hospital, Busan, Korea.
                [7 ]Department of Hematology/Oncology, Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
                [8 ]Department of Hematology/Oncology, Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.
                [9 ]Department of Hematology/Oncology, Internal Medicine, Wonkwang University Hospital, Iksan, Korea.
                [10 ]Department of Hematology/Oncology, Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea.
                [11 ]Department of Hematology/Oncology, Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
                [12 ]Department of Hematology/Oncology, Internal Medicine, Hallym University Scared Heart Hospital, Anyang, Korea.
                [13 ]Department of Hematology/Oncology, Internal Medicine, Dong-A University Hospital, Busan, Korea.
                [14 ]Department of Hematology/Oncology, Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
                [15 ]Department of Hematology/Oncology, Internal Medicine, Asan Medical Center, Seoul, Korea.
                Author notes
                Correspondence to Cheolwon Suh, M.D., Ph.D., Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@ 123456amc.seoul.kr
                Correspondence to Sang Kyun Sohn, M.D., Ph.D., Department of Hematology/Oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 200, Dongduk-ro, Jung-gu, Daegu 700-712, Korea. Tel: +82-53-420-5587, Fax: +82-53-426-2046, sksohn@ 123456knu.ac.kr

                #Cheolwon Suh and Sang Kyun Sohn contributed equally to this work.

                Article
                10.5045/br.2014.49.1.15
                3974951
                24724062
                feebd2a5-0b9f-4227-9f6d-44868e56950e
                © 2014 Korean Society of Hematology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 October 2013
                : 05 December 2013
                : 19 February 2014
                Categories
                Original Article

                mantle cell lymphoma,epidemiology,trend,survival,chemotherapy,rituximab

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