PURPOSE: Mantle-cell lymphoma (MCL) is a distinct B-cell lymphoma associated with poor outcome. In 2008, the MCL International Prognostic Index (MIPI) was developed as the first prognostic stratification tool specifically directed to patients with MCL. External validation was planned to be performed on the cohort of the two recently completed randomized trials of the European MCL Network. PATIENTS AND METHODS: Data of 958 patients with MCL (median age, 65 years; range, 32 to 87 years) treated upfront in the trials MCL Younger or MCL Elderly were pooled to assess the prognostic value of MIPI with respect to overall survival (OS) and time to treatment failure (TTF). RESULTS: Five-year OS rates in MIPI low, intermediate, and high-risk groups were 83%, 63%, and 34%, respectively. The hazard ratios for OS of intermediate versus low and high versus intermediate risk patients were 2.1 (95% CI, 1.5 to 2.9) and 2.6 (2.0 to 3.3), respectively. MIPI was similarly prognostic for TTF. All four clinical baseline characteristics constituting the MIPI, age, performance status, lactate dehydrogenase level, and WBC count, were confirmed as independent prognostic factors for OS and TTF. The validity of MIPI was independent of trial cohort and treatment strategy. CONCLUSION: MIPI was prospectively validated in a large MCL patient cohort homogenously treated according to recognized standards. As reflected in current guidelines, MIPI represents a generally applicable prognostic tool to be used in research as well as in clinical routine, and it can help to develop risk-adapted treatment strategies to further improve clinical outcome in MCL.

Achiel van Hoof A Z Sint Jan AV Brugge Belgium

Catherine Thieblemont Hôpital Saint Louis Paris

Christian H Geisler Rigshospitalet Copenhagen Denmark

Christiane Pott University Hospital Schleswig Holstein Kiel

Eva Hoster Roswitha Forstpointner Wolfgang Hiddemann Martin H Dreyling and Michael Unterhalt University Hospital Munich

Eva Hoster University of Munich Munich

Francesco Di Raimondo University of Catania Italy

Hanneke C Kluin Nelemans University of Groningen Groningen

Jan Walewski and Michal Szymczyk Maria Sklodowska Curie Memorial Institute Warsaw Poland

Jeanette Doorduijn Erasmus MC Cancer Institute Rotterdam the Netherlands

Marek Trneny Charles University General Hospital Prague Czech Republic

Michael Hallek Universität Köln Köln

Olivier Hermine University Paris Descartes and Université Sorbonne Paris Cité

Stephan Stilgenbauer University of Ulm Ulm Germany

Vincent Ribrag Institut Gustave Roussy Villejuif France

Wolfram Klapper University of Kiel

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$a Hoster, Eva $u Eva Hoster, Roswitha Forstpointner, Wolfgang Hiddemann, Martin H. Dreyling, and Michael Unterhalt, University Hospital Munich; Eva Hoster, University of Munich, Munich; Wolfram Klapper, University of Kiel; Christiane Pott, University Hospital Schleswig-Holstein, Kiel; Michael Hallek, Universität Köln, Köln; Stephan Stilgenbauer, University of Ulm, Ulm, Germany; Olivier Hermine, University Paris Descartes and Université Sorbonne Paris Cité; Catherine Thieblemont, Hôpital Saint Louis, Paris; Vincent Ribrag, Institut Gustave Roussy, Villejuif, France; Hanneke C. Kluin-Nelemans, University of Groningen, Groningen; Jeanette Doorduijn, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Jan Walewski and Michal Szymczyk, Maria Sklodowska-Curie Memorial Institute, Warsaw, Poland; Achiel van Hoof, A. Z. Sint Jan AV, Brugge, Belgium; Marek Trneny, Charles University General Hospital, Prague, Czech Republic; Christian H. Geisler, Rigshospitalet, Copenhagen, Denmark; and Francesco Di Raimondo, University of Catania, Italy.

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$a Confirmation of the mantle-cell lymphoma International Prognostic Index in randomized trials of the European Mantle-Cell Lymphoma Network / $c E. Hoster, W. Klapper, O. Hermine, HC. Kluin-Nelemans, J. Walewski, A. van Hoof, M. Trneny, CH. Geisler, F. Di Raimondo, M. Szymczyk, S. Stilgenbauer, C. Thieblemont, M. Hallek, R. Forstpointner, C. Pott, V. Ribrag, J. Doorduijn, W. Hiddemann, MH. Dreyling, M. Unterhalt,

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$a PURPOSE: Mantle-cell lymphoma (MCL) is a distinct B-cell lymphoma associated with poor outcome. In 2008, the MCL International Prognostic Index (MIPI) was developed as the first prognostic stratification tool specifically directed to patients with MCL. External validation was planned to be performed on the cohort of the two recently completed randomized trials of the European MCL Network. PATIENTS AND METHODS: Data of 958 patients with MCL (median age, 65 years; range, 32 to 87 years) treated upfront in the trials MCL Younger or MCL Elderly were pooled to assess the prognostic value of MIPI with respect to overall survival (OS) and time to treatment failure (TTF). RESULTS: Five-year OS rates in MIPI low, intermediate, and high-risk groups were 83%, 63%, and 34%, respectively. The hazard ratios for OS of intermediate versus low and high versus intermediate risk patients were 2.1 (95% CI, 1.5 to 2.9) and 2.6 (2.0 to 3.3), respectively. MIPI was similarly prognostic for TTF. All four clinical baseline characteristics constituting the MIPI, age, performance status, lactate dehydrogenase level, and WBC count, were confirmed as independent prognostic factors for OS and TTF. The validity of MIPI was independent of trial cohort and treatment strategy. CONCLUSION: MIPI was prospectively validated in a large MCL patient cohort homogenously treated according to recognized standards. As reflected in current guidelines, MIPI represents a generally applicable prognostic tool to be used in research as well as in clinical routine, and it can help to develop risk-adapted treatment strategies to further improve clinical outcome in MCL.

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