Analysis Of Clinical、Pathology Features And Prognosis And Diagnosis And Treatment Of37Patients With Mantle Cell Lymphoma

Background and Objective: Mantle cell lymphoma is a specialsubtype of lymphoma that is indolent and invasive. Its prognosis is poorer than othersmall B-cell lymphomas and the rate of long-term survival is low. In this study weretrospective analyze the clinical and pathologic features, therapeutic process, andprognosis of37MCL cases treated in our Hospital. The purpose of our study is toimprove our understanding of MCL. Method: The medical records of37patients whovisited our hospital from October2005to October2012were retrospective analyzedfor the clinical and pathologic features, the therapy they received, and the therapeuticoutcome. Results: The37cases occupied the number of Non-Hodgkin’s Lymphomapatients who visited our hospital in the same period6%, the median age of the37MCL cases was61years old (range41-78years old), peak age of onset was50-70year old. The male:female ratio was4.28:1. The superficial lymph node involvementwas common. The metastatic sites included bone marrow (48.57%), spleen (21.62%),and gastrointestinal tract (5.41%). Five patients (13.51%) presented with stage II,eight patients (21.86%) with stage III, and23patients presented with stage IV disease.The different of OS in the three groups was statistically significant;49.50months vs.41.6months vs.17.74months, P=0.004. MIPI scores of high risk were seen in16cases (43.24%), medium risk in10cases (43.24%) and low risk in10cases (29.73%).There was a significant statistical difference between the three MIPI staged groups ofpatients;45.43months vs.42.4months vs. and21.32months P=0.045. Marrowinvolvement was seen in17cases (45.95%). Patients without marrow involvementhad a better survival prognosis than patients with marrow involvement; OS65.32months vs.22.12months, P=0.01. In the37cases the blastoid variant occurred in14patients (37.84%) and the typical variant in23patients (62.16%). Survival in the thetypical variant group is better than in the blastoid group; OS38months vs.18months,P=0.028. Mitotic figures <20/10HPF were seen in24cases and≥20/10HPF were seenin13cases. Survival for the group with <20/10HPF was better than for the patients with≥20/10HP; OS50.34months vs.21.12months, P=0.04. Nodular growth wasreported in23cases (62.16%) and diffuse growth in14cases (37.84%); the two typesof growth had no obvious effect on survival; OS28.33months vs.40.46months,P=0.85. Thirty-six patient accepted a CD5assay;35(97.25%) were positive and onepatients was negative (2.78%). Thirty cases accepted CD10testing and29patientstested positive (96.67%). Twenty-two cases accepted CD23testing and only fivepatients were positive (22.73%). All cases accepted CyclinD1testing and35patientstested positive (95.59%). Twenty patients were tested for Ki-67levels and12cases(60%) had KI-67staining on>50%of cells, and eight patients (40%) had KI-67on<50%. Survival in the group <50%cells having Ki-67expression is better than forpatients who had Ki-67on≥50%; OS11.15months vs.31.62months, P=0.001.WBC counts [?], LYM counts [?], LDH and B-symptoms have no significant effect onsurvival. Patients were followed for89months (5-89months), and the follow-up ratewas100%. Twelve patients survived more than two years and seven cases survivedmore than three years. Conclusion: MCL is a rare subtype of non-Hodgkin’slymphoma, the two-year survival rate is low, and the prognosis is relatively poor. Itappears mostly in old men. In the majority of cases early signs of the disease ischaracterized by superficial lymph node enlargement, especially the cervical lymphnode. Most patients were stage IV when they visited the hospital. Extra-capsularextension is common, including marrow, spleen, and peripheral blood. It can bedivided into typical and blastoid types based on the histology. The diagnosis of MCLis dependent on histology, immune phenotyping and genetic characteristics. Cyclin D+,CD10-, CD23-are typical MCL phenotypic characteristics. FISH chromosomeanalysis detecting the t (11,14)(q13q32) translocation is the gold standard fordiagnosis of MCL. Late stage, marrow involvement, blastoid variant, mitotic figures≥20/10HPF, Ki-67+≥50%are poor prognostic factors. There is no standard first-linechemotherapy regimen. The effect of the conventional regimen CHOP is poor, and an intense chemotherapy regimen, Hyper-CVAD/MA, can improve outcome, buttreatment related toxicity problems should be monitored.