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

Eva Hoster, Martin Dreyling, Wolfram Klapper, Christian Gisselbrecht, Achiel van Hoof, Hanneke C. Kluin-Nelemans, Michael Pfreundschuh, Marcel Reiser, Bernd Metzner, Hermann Einsele, Norma Peter, Wolfram Jung, Bernhard Wörmann, Wolf-Dieter Ludwig, Ulrich Dührsen, Hartmut Eimermacher, Hannes Wandt, Joerg Hasford, Wolfgang Hiddemann and Michael Unterhalt for the German Low Grade Lymphoma Study Group (GLSG) and the European Mantle Cell Lymphoma Network
This article has an Erratum 111(12):5761


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.

  • Submitted June 16, 2007.
  • Accepted September 27, 2007.
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