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    Mantle Cell Lymphoma International Prognostic Index (MIPI)

    Predicts survival in patients with mantle cell lymphoma.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Use in patients presenting with advanced stage mantle cell lymphoma, to help prognosticate and potentially determine therapy.

    • While most patients with advanced mantle cell lymphoma need to be treated soon after diagnosis, there is growing recognition of a small percentage of very low risk patients who may not need treatment for a much longer period.
    • If Ki-67 is available, it can be added to calculate the MIPIb or “biologic" score.

    The MIPI is more specific to mantle cell lymphoma than the International Prognostic Index (IPI).

    years
    0-1
    2-4
    U/L
    U/L
    × 10³ cells/µL
    %

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • The MIPI categorizes patients into 3 risk groups: low, intermediate, or high.
    • Low-risk patients may be considered for close observation if there are no other indications for treatment.
    • However, both intermediate and high risk patients are treated with immunochemotherapy either alone or followed by autologous stem cell transplantation depending on many other patient factors such as age, comorbidities, side effect profiles, and patient preferences.

    Management

    There is diversity in clinical practice for the treatment of mantle cell lymphoma, with very few head-to-head studies of the various approaches. While we know a small number of patients with low-burden, low-risk disease may have an indolent course, it is difficult to identify those patients at diagnosis. Most patients will need treatment at diagnosis even though current treatment paradigms are not considered curative. The standard treatments are induction chemoimmunotherapy followed by autologous stem cell transplantation with or without maintenance.

    Formula

    MIPI = ( 0.03535 × age ) + 0.6978 (if ECOG >1) + [ 1.367 × log10 ( LDH / ULN ) + 0.9393 × log10 ( WBC ) ]

    If Ki-67 is available:
    MIPIb = ( 0.03535 × age ) + 0.6978 (if ECOG >1) + [ 1.367 × log10 ( LDH / ULN ) + 0.9393 × log10 ( WBC ) ] + ( 0.02142 x Ki-67 )

    Facts & Figures

    Interpretation:

    MIPI

    Risk

    Median overall survival

    <5.7

    Low

    Not reached (5 year survival 60%)

    5.7 to <6.2

    Intermediate

    51 months

    ≥6.2

    High

    29 months

     

    MIPIb

    Risk

    Median overall survival

    <5.7

    Low

    Not reached

    5.7 to <6.2

    Intermediate

    58 months

    ≥6.2

    High

    37 months

    From Hoster 2008.

    Evidence Appraisal

    The MIPI was described in 2008 using data on 455 patients from 3 clinical trials ranging from 1996-2004. A Cox regression analysis was used to backwards calculate the variables included in the MIPI, and validation was performed on the same training set by bootstrap method of validation.

    It was later independently validated in 2014 using data on 958 patients from 2 separate clinical trials from 2004-2010. This study confirmed the prognostic value of the 3 groups but with different estimated 5-year survival rates, likely reflecting the differences in the patient population and treatment. As such, the score needs to be interpreted with these factors in mind when applied to the individual patient.

    Literature

    Dr. Eva Hoster

    About the Creator

    Eva Hoster, PhD, is a professor of clinical epidemiology and medical biometry at Ludwig Maximilian University in Munich, Germany. She also serves as a researcher at the Institute for Medical Information Processing, Biometrics, and Epidemiology. Dr. Hoster’s primary research interests involve biometric consultation and supervision of medical, doctoral, and clinical research studies and projects.

    To view Dr. Eva Hoster's publications, visit PubMed

    Content Contributors
    About the Creator
    Dr. Eva Hoster
    Content Contributors