Complex karyotype in patients with mantle cell lymphoma predicts inferior survival and poor response to intensive induction therapy

I. Brian Greenwell, Ashley D. Staton, Michael J. Lee, Jeffrey M. Switchenko, Debra F. Saxe, Joseph J. Maly, Kristie A. Blum, Natalie S. Grover, Stephanie P. Mathews, Max J. Gordon, Alexey Danilov, Narendranath Epperla, Timothy S. Fenske, Mehdi Hamadani, Steven I. Park, Christopher R. Flowers, Jonathon B. Cohen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Risk stratification of newly diagnosed patients with mantle cell lymphoma (MCL) primarily is based on the MCL International Prognostic Index (MIPI) and Ki-67 proliferative index. Single-center studies have reported inferior outcomes in patients with a complex karyotype (CK), but this remains an area of controversy. METHODS: The authors retrospectively reviewed 483 patients from 5 academic centers in the United States and described the effect of a CK on survival outcomes in individuals with MCL. RESULTS: A CK was found to be associated with inferior overall survival (OS) (4.5 vs 11.6 years; P<.01) and progression-free survival (PFS) (1.9 vs 4.4 years; P<.01). In patients who underwent high-intensity induction followed by autologous stem cell transplantation (ASCT) in first remission, a CK was associated with poor OS (5.1 vs 11.6 years; P =.04) and PFS (3.6 vs 7.8 years; P<.01). Among patients with a CK, high-intensity induction had no effect on OS (4.5 vs 3.8 years; P =.77) nor PFS (2.3 vs 1.5 years; P =.46). Similarly, ASCT in first remission did not improve PFS (3.5 vs 1.2 years; P =.12) nor OS (5.1 vs 4.0 years; P =.27). On multivariable analyses with Ki-67 and MIPI, only CK was found to be predictive of OS (hazard ratio [HR], 1.98; 95% confidence interval [95% CI], 1.12-3.49 [P =.02]), whereas both CK (HR, 1.91; 95% CI, 1.17-3.12 [P =.01]) and Ki-67 >30% (HR, 1.86; 95% CI, 1.06-3.28 [P =.03]) were associated with inferior PFS. Multivariable analysis did not identify any specific cytogenetic abnormalities associated with inferior survival. CONCLUSIONS: CK appears to be independently associated with inferior outcomes in patients with MCL regardless of the intensity of induction therapy and receipt of ASCT. Cytogenetics should be incorporated into the workup of a new diagnosis of MCL and novel therapeutic approaches should be investigated for patients with CK. Cancer 2018;124:2306-15.

Original languageEnglish (US)
Pages (from-to)2306-2315
Number of pages10
JournalCancer
Volume124
Issue number11
DOIs
StatePublished - Jun 1 2018

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Mantle-Cell Lymphoma
Karyotype
Survival
Therapeutics
Cytogenetics
Chromosome Aberrations
Neoplasms

Keywords

  • chemotherapy
  • complex karyotype
  • cytogenetics
  • mantle cell lymphoma (MCL)
  • prognostic markers

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Greenwell, I. B., Staton, A. D., Lee, M. J., Switchenko, J. M., Saxe, D. F., Maly, J. J., ... Cohen, J. B. (2018). Complex karyotype in patients with mantle cell lymphoma predicts inferior survival and poor response to intensive induction therapy. Cancer, 124(11), 2306-2315. https://doi.org/10.1002/cncr.31328

Complex karyotype in patients with mantle cell lymphoma predicts inferior survival and poor response to intensive induction therapy. / Greenwell, I. Brian; Staton, Ashley D.; Lee, Michael J.; Switchenko, Jeffrey M.; Saxe, Debra F.; Maly, Joseph J.; Blum, Kristie A.; Grover, Natalie S.; Mathews, Stephanie P.; Gordon, Max J.; Danilov, Alexey; Epperla, Narendranath; Fenske, Timothy S.; Hamadani, Mehdi; Park, Steven I.; Flowers, Christopher R.; Cohen, Jonathon B.

In: Cancer, Vol. 124, No. 11, 01.06.2018, p. 2306-2315.

Research output: Contribution to journalArticle

Greenwell, IB, Staton, AD, Lee, MJ, Switchenko, JM, Saxe, DF, Maly, JJ, Blum, KA, Grover, NS, Mathews, SP, Gordon, MJ, Danilov, A, Epperla, N, Fenske, TS, Hamadani, M, Park, SI, Flowers, CR & Cohen, JB 2018, 'Complex karyotype in patients with mantle cell lymphoma predicts inferior survival and poor response to intensive induction therapy', Cancer, vol. 124, no. 11, pp. 2306-2315. https://doi.org/10.1002/cncr.31328
Greenwell, I. Brian ; Staton, Ashley D. ; Lee, Michael J. ; Switchenko, Jeffrey M. ; Saxe, Debra F. ; Maly, Joseph J. ; Blum, Kristie A. ; Grover, Natalie S. ; Mathews, Stephanie P. ; Gordon, Max J. ; Danilov, Alexey ; Epperla, Narendranath ; Fenske, Timothy S. ; Hamadani, Mehdi ; Park, Steven I. ; Flowers, Christopher R. ; Cohen, Jonathon B. / Complex karyotype in patients with mantle cell lymphoma predicts inferior survival and poor response to intensive induction therapy. In: Cancer. 2018 ; Vol. 124, No. 11. pp. 2306-2315.
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title = "Complex karyotype in patients with mantle cell lymphoma predicts inferior survival and poor response to intensive induction therapy",
abstract = "BACKGROUND: Risk stratification of newly diagnosed patients with mantle cell lymphoma (MCL) primarily is based on the MCL International Prognostic Index (MIPI) and Ki-67 proliferative index. Single-center studies have reported inferior outcomes in patients with a complex karyotype (CK), but this remains an area of controversy. METHODS: The authors retrospectively reviewed 483 patients from 5 academic centers in the United States and described the effect of a CK on survival outcomes in individuals with MCL. RESULTS: A CK was found to be associated with inferior overall survival (OS) (4.5 vs 11.6 years; P<.01) and progression-free survival (PFS) (1.9 vs 4.4 years; P<.01). In patients who underwent high-intensity induction followed by autologous stem cell transplantation (ASCT) in first remission, a CK was associated with poor OS (5.1 vs 11.6 years; P =.04) and PFS (3.6 vs 7.8 years; P<.01). Among patients with a CK, high-intensity induction had no effect on OS (4.5 vs 3.8 years; P =.77) nor PFS (2.3 vs 1.5 years; P =.46). Similarly, ASCT in first remission did not improve PFS (3.5 vs 1.2 years; P =.12) nor OS (5.1 vs 4.0 years; P =.27). On multivariable analyses with Ki-67 and MIPI, only CK was found to be predictive of OS (hazard ratio [HR], 1.98; 95{\%} confidence interval [95{\%} CI], 1.12-3.49 [P =.02]), whereas both CK (HR, 1.91; 95{\%} CI, 1.17-3.12 [P =.01]) and Ki-67 >30{\%} (HR, 1.86; 95{\%} CI, 1.06-3.28 [P =.03]) were associated with inferior PFS. Multivariable analysis did not identify any specific cytogenetic abnormalities associated with inferior survival. CONCLUSIONS: CK appears to be independently associated with inferior outcomes in patients with MCL regardless of the intensity of induction therapy and receipt of ASCT. Cytogenetics should be incorporated into the workup of a new diagnosis of MCL and novel therapeutic approaches should be investigated for patients with CK. Cancer 2018;124:2306-15.",
keywords = "chemotherapy, complex karyotype, cytogenetics, mantle cell lymphoma (MCL), prognostic markers",
author = "Greenwell, {I. Brian} and Staton, {Ashley D.} and Lee, {Michael J.} and Switchenko, {Jeffrey M.} and Saxe, {Debra F.} and Maly, {Joseph J.} and Blum, {Kristie A.} and Grover, {Natalie S.} and Mathews, {Stephanie P.} and Gordon, {Max J.} and Alexey Danilov and Narendranath Epperla and Fenske, {Timothy S.} and Mehdi Hamadani and Park, {Steven I.} and Flowers, {Christopher R.} and Cohen, {Jonathon B.}",
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TY - JOUR

T1 - Complex karyotype in patients with mantle cell lymphoma predicts inferior survival and poor response to intensive induction therapy

AU - Greenwell, I. Brian

AU - Staton, Ashley D.

AU - Lee, Michael J.

AU - Switchenko, Jeffrey M.

AU - Saxe, Debra F.

AU - Maly, Joseph J.

AU - Blum, Kristie A.

AU - Grover, Natalie S.

AU - Mathews, Stephanie P.

AU - Gordon, Max J.

AU - Danilov, Alexey

AU - Epperla, Narendranath

AU - Fenske, Timothy S.

AU - Hamadani, Mehdi

AU - Park, Steven I.

AU - Flowers, Christopher R.

AU - Cohen, Jonathon B.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - BACKGROUND: Risk stratification of newly diagnosed patients with mantle cell lymphoma (MCL) primarily is based on the MCL International Prognostic Index (MIPI) and Ki-67 proliferative index. Single-center studies have reported inferior outcomes in patients with a complex karyotype (CK), but this remains an area of controversy. METHODS: The authors retrospectively reviewed 483 patients from 5 academic centers in the United States and described the effect of a CK on survival outcomes in individuals with MCL. RESULTS: A CK was found to be associated with inferior overall survival (OS) (4.5 vs 11.6 years; P<.01) and progression-free survival (PFS) (1.9 vs 4.4 years; P<.01). In patients who underwent high-intensity induction followed by autologous stem cell transplantation (ASCT) in first remission, a CK was associated with poor OS (5.1 vs 11.6 years; P =.04) and PFS (3.6 vs 7.8 years; P<.01). Among patients with a CK, high-intensity induction had no effect on OS (4.5 vs 3.8 years; P =.77) nor PFS (2.3 vs 1.5 years; P =.46). Similarly, ASCT in first remission did not improve PFS (3.5 vs 1.2 years; P =.12) nor OS (5.1 vs 4.0 years; P =.27). On multivariable analyses with Ki-67 and MIPI, only CK was found to be predictive of OS (hazard ratio [HR], 1.98; 95% confidence interval [95% CI], 1.12-3.49 [P =.02]), whereas both CK (HR, 1.91; 95% CI, 1.17-3.12 [P =.01]) and Ki-67 >30% (HR, 1.86; 95% CI, 1.06-3.28 [P =.03]) were associated with inferior PFS. Multivariable analysis did not identify any specific cytogenetic abnormalities associated with inferior survival. CONCLUSIONS: CK appears to be independently associated with inferior outcomes in patients with MCL regardless of the intensity of induction therapy and receipt of ASCT. Cytogenetics should be incorporated into the workup of a new diagnosis of MCL and novel therapeutic approaches should be investigated for patients with CK. Cancer 2018;124:2306-15.

AB - BACKGROUND: Risk stratification of newly diagnosed patients with mantle cell lymphoma (MCL) primarily is based on the MCL International Prognostic Index (MIPI) and Ki-67 proliferative index. Single-center studies have reported inferior outcomes in patients with a complex karyotype (CK), but this remains an area of controversy. METHODS: The authors retrospectively reviewed 483 patients from 5 academic centers in the United States and described the effect of a CK on survival outcomes in individuals with MCL. RESULTS: A CK was found to be associated with inferior overall survival (OS) (4.5 vs 11.6 years; P<.01) and progression-free survival (PFS) (1.9 vs 4.4 years; P<.01). In patients who underwent high-intensity induction followed by autologous stem cell transplantation (ASCT) in first remission, a CK was associated with poor OS (5.1 vs 11.6 years; P =.04) and PFS (3.6 vs 7.8 years; P<.01). Among patients with a CK, high-intensity induction had no effect on OS (4.5 vs 3.8 years; P =.77) nor PFS (2.3 vs 1.5 years; P =.46). Similarly, ASCT in first remission did not improve PFS (3.5 vs 1.2 years; P =.12) nor OS (5.1 vs 4.0 years; P =.27). On multivariable analyses with Ki-67 and MIPI, only CK was found to be predictive of OS (hazard ratio [HR], 1.98; 95% confidence interval [95% CI], 1.12-3.49 [P =.02]), whereas both CK (HR, 1.91; 95% CI, 1.17-3.12 [P =.01]) and Ki-67 >30% (HR, 1.86; 95% CI, 1.06-3.28 [P =.03]) were associated with inferior PFS. Multivariable analysis did not identify any specific cytogenetic abnormalities associated with inferior survival. CONCLUSIONS: CK appears to be independently associated with inferior outcomes in patients with MCL regardless of the intensity of induction therapy and receipt of ASCT. Cytogenetics should be incorporated into the workup of a new diagnosis of MCL and novel therapeutic approaches should be investigated for patients with CK. Cancer 2018;124:2306-15.

KW - chemotherapy

KW - complex karyotype

KW - cytogenetics

KW - mantle cell lymphoma (MCL)

KW - prognostic markers

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DO - 10.1002/cncr.31328

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