GMCLI, Goelams Mantle Cell Lymphoma Index, a New Prognostic Index of Survival for MCL Patients Treated with VAD-C and Autologous PBSCT.

The treatment of Mantle Cell Lymphoma (MCL) and the predictive variables of response to chemotherapy and survival are largely discussed. The French Goelams group conducted between 1996 and 2000, a first line phase II prospective trial for MCL patients to test the efficacy of the VAD+C regimen, explore the effect of ASCT on patients under 60 and identify prognostic factors.

Treatment: it consisted for the first step of 4 cycles of VAD+C regimen (classical VAD with vincristine, adriblastine, dexamethasone associated with chlorambucil 12 mg/D from D20 to D29. interval between two cycles 35 days). The responders (cheson criteria) went to the second step wich consisted of 4 other VAD+C regimen for patients over 60 years or for patients under 61 years, 2 other VAD+C regimen followed by a ASCT with preparative regimen including Alkeran 140 and a 8 grays TBI.

Results: 90 patients were included and finally 74 retained after the pathologic review. Fifty (78%) were common forms and 24 blastoid variants. For the 74 eligible patients (40 under 61years and 34 over 60), the ORR after 4 cycles of VAD+C was 73% and 46% of the patients were in CR/CRu. ASCT influenced significantly the PFS, with a median survival of 20 months for non transplanted patients versus 37 months for ASCT recipients (p=0,001) and showed a tendency for a better OS (p=0.07). Six independent prognostic factors (PF) were identified as influencing OS: blastic variants, LDH level, lymphocytosis>5G/L, MIB1proliferation index, performance status and B symptoms. This allows to propose a new prognostic index which stratifies patients at diagnosis into 3 prognostic groups, with 0 or 1 PF (n=34, 46%), 2 or 3 PF (n=29, 39%) and 4 or more PF (n=11, 15%). For these three groups, median OS was respectively of 68, 41 and 7 months (p=0.0001).

Conclusion: The VAD+C regimen thus appears as a good regimen for MCL with few prognosis factors, which can effectively be completed by an ASCT for young responders’ patients.