Should There Be a Standard Therapy for Mantle Cell Lymphoma?

Mitchell R Smith

Disclosures

Future Oncol. 2011;7(2):227-237. 

In This Article

Heterogeneity of Mantle Cell Lymphoma: Clinical Determinants

The usual clinical factors that define behavior in other lymphoma subtypes similarly predict behavior of MCL. These are primarily age, performance status, stage and lactate dehydrogenase(LDH). Thus, the International Prognostic Index (IPI), developed for diffuse large cell lymphoma,[2] and the Follicular Lymphoma International Prognostic Index (FLIPI)[3] are somewhat prognostic. More recently, the MCL-specific IPI (MIPI)[4] has been defined, which similarly utilized host-specific factors of age and performance status along with biological factors of LDH, white blood cell count and Ki-67 index. High-risk patients may have a survival of 2–3 years compared with low-risk patients, who have a median overall survival of well over 5 years. The overall survival of MCL has improved from approximately 2.5 years, in European studies from 1975 to 1986, to approximately 5 years in similar patients studied from 1996 to 2004.[5] In a more recent single-institution retrospective analysis, survival was greater than 7 years, even in the absence of intensive therapy in most patients.[6] In the absence of curative therapy and with improved survival outcomes, an active-observation approach can be used in a subset of clinically stable patients with MCL. On the other hand, for those with more rapidly progressive disease, the early use of more intensive therapy is indicated.

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