Analysis of Clinical Characteristics and Prognosis of Mantle Cell Lymphoma With Gastrointestinal Involvement

Abstract

Introduction: Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma characterized by rapid disease progression. Studies on gastrointestinal (GI) involvement of MCL are lacking. In this study, we investigated the clinical features and prognosis of MCL with GI involvement. Methods: We retrospectively analyzed 64 patients who diagnosed MCL from January 2009 to April 2017 consecutively. At the time of MCL diagnosis, patients who were identified to have GI involvement by endoscopy or radiologic examination were assigned to the GI-MCL group. And those who were confirmed to have no GI involvement were assigned to the non GI-MCL group. The clinical characteristics and the outcomes of both groups were compared. Results: The GI-MCL group included 29 patients (45.3%). There were no significant differences in age and gender between the GI and non GI-MCL group. The stage of GI-MCL group was higher compared to the non GI-MCL group and all of 29 patients were stage IV. The mean of International Prognostic Index (IPI) score was also significantly higher in GI-MCL (2.97 vs. 1.97, p=0.047). Bone marrow involvement in the GI-MCL group was much greater than non GI-MCL group (69.0% vs. 40.0%, p=0.021). R-CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone combined with rituximab) was the most abundant in 1st line chemotherapy (44/64, 69.8%). After 1st line chemotherapy, 56 of 64 patients showed complete remission (87.5%). Although there was no difference in complete remission rate between the two groups, recurrence rate was much higher in GI-MCL group (72.% vs. 41.2%, p=0.024). A total of 15 patients received bone marrow transplantation (15/64, 23.4%). The median follow up period was 37 months and 11 out of 64 patients died during this period (17.2%). There was no significant difference in mortality between the two groups. Conclusion: The patients with MCL invading GI tract tended to have advanced stage, higher IPI score, more bone marrow involvement and more recurrence than MCL not involving the GI tract. Endoscopic examination to rule out GI involvement in patients with MCL is warranted.