MANTLE CELL LYMPHOMA - A RETROSPECTIVE STUDY OF 121 CASES

Mantle cell lymphoma (MCL) patients represent a difficult problem, som etimes to establish the diagnosis but mostly because of their refracto riness to standard lymphoma treatments. Which treatments to apply and to whom is not yet defined. In this study, we attempted to analyze the clinical features, to identify the major prognostic factors, and to e valuate the outcome of 121 MCL patients treated in our institution bet ween 1979 and 1997. Clinical data, treatment modalities, and Internati onal Prognostic Index (IPI) score were evaluated. Median age was 63 ye ars. Patients usually presented with advanced stage disease (87%), dis seminated lymph nodes (57%), bone marrow involvement (79%), but with a good performance status (PS) (81%). Lymphocytosis > 4000/mu l and/or peripheral blood involvement was present in 36% of cases, and gastroin testinal disease in 18%. The t(11;14)(q13;q32) and/or bcl-1 rearrangem ent was detected in 47/57 studied cases. Median overall survival (OS) was 3.12 years and a longer survival was significantly associated with younger age (< 70 years), good PS (< 2), localized disease (stage I-I I), fewer than two extra-nodal sites, absence of spleen or peripheral blood involvement, normal serum LDH and PP-microglobulin levels, and h emoglobin level greater than 12 g/dl. However, the IPI failed to ident ify patients with longer OS and in a multiparametric analysis, only ol der age, hemoglobin less than 12 g/dl, poor PS, and blood involvement were associated with a poorer outcome. Treatment modalities had no imp act on survival with 75% of patients relapsing or progressing. Our dat a showed that the poor outcome of MCL patients is mainly related to ad verse patient characteristics, a highly disseminated tumor, and some u nknown parameters associated with the refractoriness to standard thera py.