Mantle Cell Lymphoma International Prognostic Index (MIPI)

Why Use

The MIPI is more specific to mantle cell lymphoma than the International Prognostic Index (IPI) .

When to Use

Use in patients presenting with advanced stage mantle cell lymphoma, to help prognosticate and potentially determine therapy.

Formula

Pearls / Pitfalls

While most patients with advanced mantle cell lymphoma need to be treated soon after diagnosis, there is growing recognition of a small percentage of very low risk patients who may not need treatment for a much longer period. If Ki-67 is available, it can be added to calculate the MIPIb or “biologic" score.

Management

There is diversity in clinical practice for the treatment of mantle cell lymphoma, with very few head-to-head studies of the various approaches. While we know a small number of patients with low-burden, low-risk disease may have an indolent course, it is difficult to identify those patients at diagnosis. Most patients will need treatment at diagnosis even though current treatment paradigms are not considered curative. The standard treatments are induction chemoimmunotherapy followed by autologous stem cell transplantation with or without maintenance.

Advice

The MIPI categorizes patients into 3 risk groups: low, intermediate, or high. Low-risk patients may be considered for close observation if there are no other indications for treatment. However, both intermediate and high risk patients are treated with immunochemotherapy either alone or followed by autologous stem cell transplantation depending on many other patient factors such as age, comorbidities, side effect profiles, and patient preferences.

More Information

Interpretation: MIPI Risk Median overall survival <5.7 Low Not reached (5 year survival 60%) 5.7 to <6.2 Intermediate 51 months ≥6.2 High 29 months MIPIb Risk Median overall survival <5.7 Low Not reached 5.7 to <6.5 Intermediate 58 months ≥6.5 High 37 months From Hoster 2008 .