Using Primary Site as a Predictor of Survival in Mantle Cell Lymphoma Open Access

Ambinder, Alexander Joseph (2013)

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Background: Mantle cell lymphoma (MCL) is a rare B-cell lymphoma that varies in clinical behavior with some patients experiencing aggressive disease with short survival while others have MCL characterized by indolent behavior. We examined the association between primary disease site and survival in MCL patients to identify subgroups with distinct characteristics.

Methods: We analyzed data pertaining to MCL cases reported the United States Surveillance, Epidemiology and End Results program from 2000-2009. Kaplan Meier curves and Cox proportional hazard models were used to estimate the effect of primary site on survival.

Results: Among 4,477 cases included in our study, 19.6% of patients presented with an extranodal primary site. The most common extranodal primary sites were of the gastro-intestinal (GI) tract (7.8%), the head and neck (6.2%), and the hematologic/reticuloendothelial systems (3.6%). Asians/Pacific Islanders were more likely than Whites or Blacks to have GI tract or head and neck disease (p<0.0001 and p=0.002, respectively). Advanced disease and B-symptoms were less common in those with primary disease of the GI tract or head and neck than in those with primary disease of the lymph nodes (both p<0.0001). In a multivariable Cox regression model, patients with primary disease of the GI tract and head and neck had superior survival compared to those with primary disease of the lymph nodes; hazard ratios 0.75 (95% CI 0.62-0.90) and 0.68 (95% CI 0.55-0.85), respectively.

Conclusion: Primary site of disease may be an important prognostic factor for patients with MCL. Further studies elucidating a biological basis for these differences are needed.

Table of Contents

Chapter I

1.Background 1

Chapter II (Manuscript)

1.Title, Authors 6

2.Introduction 7

3.Methods 8

4.Results 11

5.Discussion 13

6.Conclusion 17

7.References 19

8.Table 1 27

9.Table 2 28

10.Table 3 29

11.Figure Legends 30

12.Figure 1 31

13.Figure 2 32

Chapter III

1.Summary 33

2.Public Health Implications 34

3.Possible Future Directions 35

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