ORIGINAL PAPER Outcome prediction of advanced mantle cell lymphoma by international prognostic index versus different mantle cell lymphoma indexes: one institution study Milena Todorovic • Bela Balint • Bosko Andjelic • Dejana Stanisavljevic • Nada Kraguljac Kurtovic • Ziv Radisavljevic • Biljana Mihaljevic Received: 12 August 2011 / Accepted: 5 December 2011 / Published online: 15 December 2011 Ó Springer Science+Business Media, LLC 2011 Abstract The aim of this study was to evaluate the prognostic significance of international prognostic index (IPI), mantle cell lymphoma IPI (MIPI), simplified MIPI (sMIPI), and MIPI biological (MIPIb), as well as their correlation with immunophenotype, clinical characteristics, and overall survival (OS), in a selected group of 54 patients with advanced-stage mantle cell lymphoma (MCL), treated uniformly with CHOP. Seventeen patients had IV clinical stage (CS), while other 37 had leukemic phase at presen- tation. Diffuse type of marrow infiltration was verified in 68.5% and nodular in remainder patients. Extranodal localization (25.9%) included bowel (20.4%), pleural effusion, sinus, and palpebral infiltration. All of analyzed patients expressed typical MCL immunophenotypic profile: CD19 ? CD20 ? CD22 ? CD5 ? Cyclin-D1 ? FMC7 ? CD79b ? smIg ? CD38 ?/- CD23 - CD10 - . Median OS of the whole group was 23 months, without significant differences between IV CS and leukemic phase patients. Thirty-two patients (59.3%) responded to initial treatment, 9 (16.7%) with complete and 23 (42.6%) with partial remission. Negative prognostic influence on OS had high IPI (P \ 0.01), high sMIPI (P \ 0.001), MIPI (P \ 0.01), MIPIb (P \ 0.01), extranodal localization (P \ 0.01), and diffuse marrow infiltration (P \ 0.01). Testing between randomly selected groups showed that patients with lower proportion of CD5 ? cells ( \ 80%) correlated with cyto- logical blastoid variant and had shorter survival comparing with the group with higher proportion of CD5 ? cells ( [ 80%) (P \ 0.01). Using univariate Cox regression, we proved that IPI, sMIPI, MIPI, and MIPIb had an indepen- dent predictive importance (P \ 0.01) for OS in uniformly treated advanced MCL patients, although sMIPI prognostic significance was the highest (P \ 0.001). Keywords Mantle cell lymphoma Á IPI Á sMIPI Á MIPI Á MIPIb Introduction Mantle cell lymphoma (MCL) is a distinct lymphoma subtype that has been more precisely defined at present due to the integration of immunophenotypic, molecular, and clinicopathologic studies. Briefly, MCL is a malignancy with affected B-cell lineage on the basis of specific molecular genetics, characterized by the t(11;14)(q13;q32) that involving Cyclin-D1 gene over-expression and resulting alterations [1, 2]. MCL occurs in elderly adults, M. Todorovic (&) Á B. Andjelic Á N. K. Kurtovic Á B. Mihaljevic Clinic of Hematology, Clinical Center of Serbia, 11000 Belgrade, Serbia e-mail: bb.lena@gmail.com M. Todorovic Á D. Stanisavljevic Á B. Mihaljevic Faculty of Medicine, University of Belgrade, Belgrade, Serbia B. Balint Institute for Medical Research, University of Belgrade, Belgrade, Serbia B. Balint Institute of Transfusiology, Military Medical Academy, Belgrade, Serbia D. Stanisavljevic Institute for Medical Statistics and Informatics, Belgrade, Serbia Z. Radisavljevic Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA 123 Med Oncol (2012) 29:2212–2219 DOI 10.1007/s12032-011-0136-1