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. 2010 Jan;21(1):133-9.
doi: 10.1093/annonc/mdp495.

Prognostic impact of proliferative index determined by quantitative image analysis and the International Prognostic Index in patients with mantle cell lymphoma

R Schaffel  1 , C V Hedvat, J Teruya-Feldstein, D Persky, J Maragulia, D Lin, C S Portlock, C H Moskowitz, A D Zelenetz
Affiliations

Prognostic impact of proliferative index determined by quantitative image analysis and the International Prognostic Index in patients with mantle cell lymphoma

R Schaffel et al. Ann Oncol. 2010 Jan.

Abstract

Background: The proliferative index (PI) is a powerful prognostic factor in mantle cell lymphoma (MCL); however, its utility is hampered by interobserver variability. The mantle cell international prognostic index (MIPI) has been reported to have prognostic importance. In this study, we determined the prognostic value of the PI as determined by quantitative image analysis in MCL.

Patients and methods: Eighty-eight patients with adequate tissue were included in this analysis. Patients were treated with one of two treatment programs: sequential therapy with high-dose therapy consolidation or radioimmunotherapy followed by combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone. Patients were divided into four groups based on PI (<10%, 10%-29.9%, 30%-49.9%, and >50%), and outcomes were analyzed.

Results: Thirty percent was identified as the optimal cut-off for PI. By univariate analysis, intensive treatment and a low PI were associated with a superior progression-free survival (PFS); only PI was associated with overall survival. By multivariate analysis, both intensive treatment and PI correlated with PFS. The MIPI had no prognostic impact.

Conclusions: PI is the most important prognostic factor in MCL. The cut-off of 30% is clinically meaningful and can be used to tailor the intensity of therapy in future clinical trials.

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Figures

Figure 1.
Figure 1.
Progression-free survival (A) and overall survival (B) of patients with mantle cell lymphoma according to the proliferative index (Ki-67): <10% (blue); 10%–29.9% (green); 30%–49.9% (yellow); ≥50% (pink).
Figure 2.
Figure 2.
Progression-free survival (A, B) and overall survival (C, D) according to the proliferative index (PI) higher or lower than 30% (A, C) or 50% (B, D) in 88 patients with mantle cell lymphoma.
Figure 3.
Figure 3.
Progression-free survival (A) and overall survival (B) of patients with mantle cell lymphoma according to mantle cell international prognostic index score.
Figure 4.
Figure 4.
Progression-free survival (A) and overall survival (B) of patients with mantle cell lymphoma and a proliferative index <30% according to the planned therapy [high-dose chemotherapy with autologous stem-cell rescue (HDT/ASCR) or radioimmunotherapy followed by combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (RIT-CHOP)].
See this image and copyright information in PMC

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