Prognostic Markers for Therapy Selection in Mantle Cell Lymphoma

In the second installment of this 3-part video series, Jonathon Cohen, MD, MS, Assistant Professor, Lymphoma Group, Winship Cancer Institute at Emory University, Atlanta, Georgia, discusses the Mantle Cell Lymphoma International Prognostic Index (MIPI), the Ki-67 proliferative index, and various molecular assessments that can be informative in determining which patients will benefit from specific therapies.

Transcript

Mantle cell lymphoma has historically been associated with a very poor prognosis. Fortunately, in recent years, we've identified a number of therapies including cytarabine-based induction regimens, autologous stem cell transplantation, as well as some novel agents used in the relapse setting that have significantly prolonged life expectancy for patients with newly diagnosed disease.

However, there are still a high number of patients who will respond and an additional number of patients who won't respond to initial therapy or who have early relapse. We've looked at a number of prognostic markers. There are several factors which are readily available at the time of diagnosis, which make up the Mantle Cell Lymphoma International Prognostic Index, or MIPI.

In addition, I often use the Ki-67 proliferative index as a marker of aggressive disease as well, using 30 percent as the cut-off. Fortunately, in recent years, MIPI and Ki-67 have been combined to form the MIPI-C, or Combined MIPI, which better highlights those patients that are the highest risk versus those that are lower risk.

In addition to these readily available factors, there are a number of molecular assessments that can be done, including assessment for TP53 mutations, which have been associated with a markedly inferior outcome for patients, even those that receive the most aggressive therapies that we offer.

In additional, cytogenetics and other specific genetic abnormalities may ultimately prove to be informative as we determine which patients may benefit from specific therapies. Unfortunately, at the current time, we don't have specific therapies to offer for patients that are high risk. That is an area of unmet medical need.