Considering the Value of the MIPI Score in MCL

Michael L. Wang, MD:The MIPI score for this patient is over 6, and MIPI scores are used very often during publications. When you publish something on mantle cell lymphoma, you have to use the MIPI score, but not all doctors calculate a MIPI score before they give therapy. For example, this patient—first of all, he needs therapy, because he has symptoms and a big tumor. You cannot wait anymore.

So, you do not need a MIPI score to tell you that this patient needs immediate therapy. You cannot watch and wait. This patient has a big tumor, has tumors above and below the diaphragm, and is young. Therefore, he needs intensive therapy. Although a MIPI score could tell you that he needs intensive therapy, this is a young patient who is less than 65-years-old who needs immediate therapy. And the regular therapies—R-CHOP [rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone] or R-bendamustine—are inadequate for this patient. So, this patient has to get intensive therapy. I agree with that, but I’m conducting a clinical trial to pick the standard therapy.

If you’re very familiar with the therapy and natural history of mantle cell lymphoma, you don’t need a MIPI score. But if you don’t treat it yearly—on average, community doctors in their entire oncological career treat 1 to 2 patients with mantle cell lymphoma. So, if you’re a community oncologist and you have not seen more than 5 patients with mantle cell lymphoma, you really need to know the prognosis. Please calculate the MIPI. The MIPI calculation is rather complicated if you do it manually, but there’s an online formula. You can Google the online formula, put in the parameters, and the value will come out.

Transcript edited for clarity.

March 2013

• A 55-year-old male presents to his physician complaining of fatigue, unexplained weight loss, and neck swelling
• PMH: unremarkable
• Physical exam:
  • Bilateral cervical lymphadenopathy
• Laboratory findings:
  • Leukocytes, 9.0 X 10⁹/L
  • Hb, 9.8 g/dL
  • LDH, 520 U/L
  • Beta2-microglobulin; 6.4 mg/L
  • AST, 167 U/L; ALT 202 U/L
• Excisional biopsy of the right cervical node:
  • Immunophenotyping: IgM+, CD5+, CD10-, CD19+, CD20+, CD22+, CD23-, cyclin D1+
  • Cytogenetics: t(11;14)(q13;q32)
• CT imaging of the neck, chest, abdomen, pelvis: marked¹⁸F-FDG uptake and enlargement of bilateral cervical lymph nodes (right, 4.6 cm; left, 3.1 cm) and mesenteric lymph node (9.2 cm)
• Diagnosis: Mantle-cell lymphoma, Ann Arbor stage III
• The patient was started on induction therapy with R-hyper-CVAD and achieved significant reduction in tumor burden
• Consolidation with autologous stem cell transplant resulted in complete remission

March 2017

• The patient reports having symptoms of fatigue and weight loss
• PET/CT shows diffuse uptake of¹⁸F-FDG in the right lung and mediastinal lymph nodes
• The patient was started on therapy with ibrutinib