Analysis Of Clinicopathological Features And Prognostic Factors Of Mantle Cell Lymphoma

Objective: To analyze clinicopathological features and prognostic factors of mantle cell lymphoma(MCL)over the past 10 years retrospectively.To explore the expression of programmed cell death 1(PD-1)and programmed death ligand-1(PD-L1)in MCL tissues.Methods: A total of 73 cases of initially diagnosed with MCL at Affiliated Tumor Hospital of Guangxi Medical University between January 2008 to October 2017 were enrolled.The clinicopathological features were summarized.Prognostic analysis were conducted on the clinicopathological features and the first-line treatment protocols of these patients.And the expression of PD-1 and PD-L1 were detected by Immunohistochemistry on 47 cases of paraffin embedded tissue of MCL.Results:1.Among the 73 MCL patients,the median age was 60 years(32-83 years)and the ratio of male to female was 3.87:1.There were 57 cases(78.1%)presented with Ann Arbor stage ?-? and 40 cases(54.8%)with extranodal involvement.According to Mantle cell lymphoma International Prognostic Index(MIPI),35 patients(47.9%)were classified as low risk,21 patients(28.8%)as intermediate risk and 17 patients(23.3%)as high risk.2.Treatment protocols of 66 patients were analyzed.The objective respsonse rate(ORR)of patients treated with Rituximab combined with chemotherapy was significantly superior than those with chemotherapy(85.0% vs 48.9%,P=0.021).The ORR of patients treated with CHOP alternated with DHAP was significantly superior than those with CHOP alone.3.ECOG performance status,Ki-67,?2 microglobulin,maximal diameter of tumor,extranodal involvement,bone marrow infiltration,Ann Arbor stage,and MIPI prognostic score showed prognostic relevance for PFS(P<0.05).ECOG performance status,Ki-67,?2 microglobulin,maximal diameter of tumor,extranodal involvement,bone marrow infiltration,Ann Arbor stage,MIPI prognostic score and treatment protocols had a significant impact on OS.4.Multivariate analysis showed that Ki-67(HR,3.664;95% CI,1.305-10.177;P=0.014)and ?2 microglobulin(HR,3.003;95% CI,1.111-8.116;P=0.030)were identified as the independent prognostic factors for PFS.MIPI prognostic score(HR,2.714;95% CI,1.263-8.692;P=0.039),bone marrow infiltration(HR,2.681;95% CI,1.365-11.362;P=0.017),chemotherapy regimens(HR,0.278;95% CI,0.126-2.175;P=0.046)were identified as the independent prognostic factors for OS.5.In 47 cases of paraffin embedded tissue of MCL,the immunostain of PD-1 was negative(0/47),and the expression of PD-L1 protein was 2.1%(1/47).Conclusion: 1.MCL is mostly common in elderly male.The majority of patients presents with stage ?-? and extranodal involvement at diagonosis.2.Induction therapy including Rituximab and cytarabine can lead to better response and prolonged survival.3.MIPI is a helpful prognostic classification tool for MCL.Ki-67 is a biological prognostic factor independently from MIPI.4.PD-1 and PD-L1 blockade may not be the candidate for MCL therapy.