Dr. Goy on Prognostic Markers in Mantle Cell Lymphoma

Andre Goy, MD, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses prognostic markers in mantle cell lymphoma (MCL).

One of the big problems in the treatment of MCL is chemoresistance, but physicians have been able to identify prognostic markers in MCL, says Goy. Poor risk factors include a high MCL Prognosis (MIPI) score—these patients do worse even after high-dose therapy. The patients who have high Ki-67 of more than 30%, a blastoid presentation, or p53 are also deemed poor-risk. One of the most important factors is the presence of p53 abnormalities or 17p deletion, which Goy believes in underestimated.

Now, physicians routinely test patients for mutations. A pilot study was done that included next-generation sequencing and concluded that among the common ATM abnormalities that were found, up to 23% to 30% of patients had p53 abnormalities. These patients need new options regardless of their age, because they do poorly after high-dose therapy and transplant, says Goy. Stratification will soon depend on molecular testing, Goy predicts, because then physicians will be able to identify the subset of patients who need a chemo-free option that is not dependent on the p53 pathway.