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 language | English (US) |
|---|---|
| Pages (from-to) | 2306-2315 |
| Number of pages | 10 |
| Journal | Cancer |
| Volume | 124 |
| Issue number | 11 |
| DOIs | |
| State | Published - Jun 1 2018 |
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Keywords
- chemotherapy
- complex karyotype
- cytogenetics
- mantle cell lymphoma (MCL)
- prognostic markers
ASJC Scopus subject areas
- Oncology
- Cancer Research
Cite this
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 journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85044426982&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044426982&partnerID=8YFLogxK
U2 - 10.1002/cncr.31328
DO - 10.1002/cncr.31328
M3 - Article
C2 - 29579328
AN - SCOPUS:85044426982
VL - 124
SP - 2306
EP - 2315
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 11
ER -