Blood Res.  2014 Mar;49(1):15-21. 10.5045/br.2014.49.1.15.

Clinical features and treatment outcomes in patients with mantle cell lymphoma in Korea: Study by the Consortium for Improving Survival of Lymphoma

• Kang BW
• Sohn SK
• Moon JH
• Chae YS
• Kim JG
• Lee SJ
• Kim WS
• Lee JJ
• Lee SR
• Park KU
• Lee HS
• Lee WS
• Won JH
• Park MR
• Kwak JY
• Kim MK
• Kim HJ
• Oh SY
• Kang HJ
• Suh C

• KMID: 2172818
• DOI: http://doi.org/10.5045/br.2014.49.1.15

Abstract

BACKGROUND
We investigated the clinical features and treatment outcomes of patients with mantle cell lymphoma (MCL) in Korea.
METHODS
We retrospectively analyzed the clinical characteristics and prognosis of 131 patients diagnosed with MCL between January 2004 and December 2009 at 15 medical centers in Korea; all patients received at least 1 chemotherapeutic regimen for MCL.
RESULTS
The median age for the patients was 63 years (range, 26-78 years), and 77.9% were men. A total of 105 patients (80.1%) had stage III or IV MCL at diagnosis. Fifty-two patients (39.7%) were categorized with high- or high-intermediate risk MCL according to the International Prognostic Index (IPI). Eighteen patients (13.7%) were in the high-risk group according to the simplified MCL-IPI (MIPI). The overall incidence of extranodal involvement was 69.5%. The overall incidence of bone marrow and gastrointestinal involvements at diagnosis was 41.2% and 35.1%, respectively. Cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab were used frequently as the first-line treatment (41.2%). With a median follow-up duration of 20.0 months (range, 0.2-77.0 months), the overall survival (OS) at 2 years was 64.7%, while the event-free survival (EFS) was 39.7%. Multivariate analysis showed that the simplified MIPI was significantly associated with OS. However, the use of a rituximab-containing regimen was not associated with OS and EFS.
CONCLUSION
Similar to results from Western countries, the current study found that simplified MIPI was an important prognostic factor in Korean patients with MCL.

Keyword

Mantle cell lymphoma; Epidemiology; Trend; Survival; Chemotherapy; Rituximab

MeSH Terms

Bone Marrow
Cyclophosphamide
Diagnosis
Disease-Free Survival
Doxorubicin
Drug Therapy
Epidemiology
Follow-Up Studies
Humans
Incidence
Korea*
Lymphoma*
Lymphoma, Mantle-Cell*
Male
Multivariate Analysis
Prednisolone
Prognosis
Retrospective Studies
Vincristine
Rituximab
Cyclophosphamide
Doxorubicin
Prednisolone
Vincristine

Figure

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  Fig. 1 Kaplan-Meier analysis of overall survival and event-free survival.

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  Fig. 2 Kaplan-Meier analysis of (A) overall survival and (B) event-free survival based on the International Prognostic Index.

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  Fig. 3 Kaplan-Meier analysis of (A) overall survival and (B) event-free survival based on the Mantle Cell Lymphoma International Prognostic Index.

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  Fig. 4 Kaplan-Meier analysis of (A) overall survival and (B) event-free survival based on rituximab-containing therapy as the first-line treatment.

Reference

1. Zhou Y, Wang H, Fang W, et al. Incidence trends of mantle cell lymphoma in the United States between 1992 and 2004. Cancer. 2008; 113:791–798. PMID: 18615506.

2. Aschebrook-Kilfoy B, Caces DB, Ollberding NJ, Smith SM, Chiu BC. An upward trend in the age-specific incidence patterns for mantle cell lymphoma in the USA. Leuk Lymphoma. 2013; 54:1677–1683. PMID: 23350889.

3. Ghielmini M, Zucca E. How I treat mantle cell lymphoma. Blood. 2009; 114:1469–1476. PMID: 19556426.

4. Chim CS, Chan AC, Choo CK, Kwong YL, Lie AK, Liang R. Mantle cell lymphoma in the Chinese: clinicopathological features and treatment outcome. Am J Hematol. 1998; 59:295–301. PMID: 9840910.

5. Herrmann A, Hoster E, Zwingers T, et al. Improvement of overall survival in advanced stage mantle cell lymphoma. J Clin Oncol. 2009; 27:511–518. PMID: 19075279.

6. Leitch HA, Gascoyne RD, Chhanabhai M, Voss NJ, Klasa R, Connors JM. Limited-stage mantle-cell lymphoma. Ann Oncol. 2003; 14:1555–1561. PMID: 14504058.

7. Oinonen R, Franssila K, Teerenhovi L, Lappalainen K, Elonen E. Mantle cell lymphoma: clinical features, treatment and prognosis of 94 patients. Eur J Cancer. 1998; 34:329–336. PMID: 9640217.

8. Ko YH, Kim CW, Park CS, et al. Hematolymphoreticular Study Group of the Korean Society of Pathologists. REAL classification of malignant lymphomas in the Republic of Korea: incidence of recently recognized entities and changes in clinicopathologic features. Revised European-American lymphoma. Cancer. 1998; 83:806–812. PMID: 9708949.

9. Goy A, Kahl B. Mantle cell lymphoma: the promise of new treatment options. Crit Rev Oncol Hematol. 2011; 80:69–86. PMID: 21168343.

10. Tiemann M, Schrader C, Klapper W, et al. Histopathology, cell proliferation indices and clinical outcome in 304 patients with mantle cell lymphoma (MCL): a clinicopathological study from the European MCL Network. Br J Haematol. 2005; 131:29–38. PMID: 16173960.

11. Hoster E, Dreyling M, Klapper W, et al. A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma. Blood. 2008; 111:558–565. PMID: 17962512.

12. Coiffier B. Rituximab in diffuse large B-cell lymphoma. Clin Adv Hematol Oncol. 2004; 2:156–157. PMID: 16166943.

13. Williams ME, Connors JM, Dreyling MH, et al. Mantle cell lymphoma: report of the 2010 Mantle Cell Lymphoma Consortium Workshop. Leuk Lymphoma. 2011; 52:24–33. PMID: 21133727.

14. Ferry JA. Extranodal lymphoma. Arch Pathol Lab Med. 2008; 132:565–578. PMID: 18384208.

15. A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. 1993; 329:987–994. PMID: 8141877.

16. Armitage JO. Staging non-Hodgkin lymphoma. CA Cancer J Clin. 2005; 55:368–376. PMID: 16282281.

17. Sabattini E, Bacci F, Sagramoso C, Pileri SA. WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview. Pathologica. 2010; 102:83–87. PMID: 21171509.

18. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007; 25:579–586. PMID: 17242396.

19. Bertini M, Rus C, Freilone R, et al. Mantle cell lymphoma: a retrospective study on 27 patients. Clinical features and natural history. Haematologica. 1998; 83:312–316. PMID: 9592980.

20. Bosch F, Lopez-Guillermo A, Campo E, et al. Mantle cell lymphoma: presenting features, response to therapy, and prognostic factors. Cancer. 1998; 82:567–575. PMID: 9452276.

21. Kauh J, Baidas SM, Ozdemirli M, Cheson BD. Mantle cell lymphoma: clinicopathologic features and treatments. Oncology (Williston Park). 2003; 17:879–891. 896PMID: 12846128.

22. Weisenburger DD, Vose JM, Greiner TC, et al. Mantle cell lymphoma. A clinicopathologic study of 68 cases from the Nebraska Lymphoma Study Group. Am J Hematol. 2000; 64:190–196. PMID: 10861815.

23. Romaguera JE, Medeiros LJ, Hagemeister FB, et al. Frequency of gastrointestinal involvement and its clinical significance in mantle cell lymphoma. Cancer. 2003; 97:586–591. PMID: 12548600.

24. Chung Kim Yuen C, Tomowiak C, Yacoub M, Barrioz T, Barrioz C, Tougeron D. A rare case of mantle cell lymphoma as lymphomatous polyposis with widespreadinvolvement of the digestive tract. Clin Res Hepatol Gastroenterol. 2011; 35:74–78. PMID: 21074342.

25. Sikalias N, Alexiou K, Demonakou M, Mylona SC, Papadaki T, Ekonomou N. Non-polypoidal, synchronous mantle-cell lymphoma of small intestine: a rare case. World J Surg Oncol. 2010; 8:69. PMID: 20707926.

26. Molina TJ, Delmer A, Cymbalista F, et al. Mantle cell lymphoma, in leukaemic phase with prominent splenomegaly. A report of eight cases with similar clinical presentation and aggressive outcome. Virchows Arch. 2000; 437:591–598. PMID: 11193469.

27. Lenz G, Dreyling M, Hoster E, et al. Immunochemotherapy with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone significantly improves response and time to treatment failure, but not long-term outcome in patients with previously untreated mantle cell lymphoma: results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). J Clin Oncol. 2005; 23:1984–1992. PMID: 15668467.

28. Hess G. New combinations for mantle cell lymphoma: concerted action needed. Lancet Oncol. 2011; 12:315–316. PMID: 21440504.

29. Vose JM. Mantle cell lymphoma: 2012 update on diagnosis, risk-stratification, and clinical management. Am J Hematol. 2012; 87:604–609. PMID: 22615102.