Post-treatment PET scan is highly predictive of outcome (PFS and OS) in MCL pts treated with R-Hyper-CVAD in the frontline setting regardless of MIPI score.

Lymphoma and Plasma Cell Disorders
Session Type and Session Title: 
General Poster Session, Lymphoma and Plasma Cell Disorders
Abstract Number: 
J Clin Oncol 32:5s, 2014 (suppl; abstr 8557)
Anthony R. Mato, Ewelina Protomastro, Tania Zielonka, Tatyana Feldman, Harry Agress, Mary Timberg, Gabriella Gadaleta, Pritish Bhattacharyya, Alexandria Campaiola, Jakub Svoboda, Susan Stives, Coleen Bejot, Kar Fai Chow, Larysa Jessica Gromko, Andrew Pecora, Andre Goy; John Theurer Cancer Center, Hackensack, NJ; Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA; Department of Internal Medicine, Rutgers University-New Jersey Medical School, Newark, NJ

Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).

Abstract Disclosures


Background: MIPI score (age, LDH, WBC, ECOG PS) defines 3 distinct risk groups in MCL pts. Though MIPI has been validated in series with dose intensive (DI) strategies and rituximab, a number of other prognostic factors have been reported that affect MCL survival. There remains a need to further stratify pts in each MIPI risk category despite optimal treatment approaches. We previously identified (Mato et al, Cancer 2012) FDG PET-CT as an important prognostic marker for survival in MCL pts following R-HyperCVAD completion. We examined here the additive prognostic utility of post-treatment PET-CT imaging to baseline MIPI scores. Methods: Primary endpoints were PFS and OS. PET-CT images were dichotomized using IHP response criteria (Juweid et al, JCO 2007). Reviewers were blinded to outcomes. MIPI scores were calculated as described by Hoster et al (Blood, 2008). Utilizing KM methods, we compared outcomes stratified by post-treatment PET-CT status and MIPI risk groups. Utilizing Cox regression, we tested the association between PET-CT + MIPI and survival. Results: 140 MCL pts (med age 60, 95% stage IV) treated with 1st line R-HyperCVAD were identified in our MCL outcome database. Of these, 58 pts had a post-treatment PET-CT available for review. MIPI scores were 44% low, 34% intermediate and 22% high risk. Post treatment PET-CTs were 18% (+) and 82% (-). Med PFS and OS estimates were 56 and 108 mo respectively (med follow up 35.2 mo). Both MIPI (HR 1.9 CI: 1.1-3.2 p=.012) and PET-CT (HR 7.1 CI:2.9-17.1 p=.001) independently correlated with PFS and OS MIPI (HR 3.3 CI: 1.5-7.3 p=.04) and PET-CT (HR 9.2 CI: 2.5-33.0 p=.001). The following defines a model, which includes baseline MIPI and PET-CT status: Low MIPI (HR=1), Int MIPI (HR=2.1), High MIPI (HR=3.5), PET-CT (-) (HR=1), PET-CT (+) (HR=7.1). Conclusions: Post treatment FDG-PET status and MIPI are validated independent predictors of survival in MCL pts treated with R-HyperCVAD. Outcomes are extremely poor in PET (+) patients regardless of MIPI risk group: Low risk / PET (+) had similar PFS as high risk / PET (-). Our results may identify MCL patient candidates for novel maintenance / consolidation approaches after 1st line therapy.