Evaluation of Ki-67 expression and large cell content as prognostic markers in MZL: a multicenter cohort study
Year: 2024
Type: article
Study design: Observational Study
Abstract: Marginal zone lymphoma (MZL) can have varied presentations and pathologic features, including high Ki-67 expression ( > 20%) as well as increased numbers of large B cells (LC). However, there are limited data available demonstrating the prognostic significance of these variables in patients with MZL. In this multi-institutional retrospective cohort study of patients with MZL treated at 10 centers, we evaluated the association between the presence of Ki-67 expression and increased LCs on survival and risk of histologic transformation (HT). A total of 785 patients were included (60% with extranodal MZL, 20% with nodal MZL, and 20% with splenic MZL). Among the 440 patients with Ki-67 staining, 22% had high Ki-67 (Ki-67 >20%). The median progression-free survival (PFS) for patients with high Ki-67 was 5.4 years compared to 7.0 years for patients with low Ki-67 (HR = 1.45, 95%CI = 1.03-2.05). Ki-67 > 20% strongly correlated with high LDH level. The risk of HT was higher in patients with increased Ki-67 than those without (5-year risk, 9.8% vs 3.87%, p = 0.01). Twelve percent of patients had LC reported on biopsy with 6% having >10% LC. The presence of LC was associated with high Ki-67 (p < 0.001), but not associated with shorter PFS or overall survival (OS). The cumulative risk for HT was higher in patients with LC compared to those without LC (5-year risk, 9.4% vs 2.9%, p = 0.04). Receipt of anthracycline-based therapy did not impact PFS or OS in either group. Ki-67 staining >20% was a prognostic factor for worse survival and strongly correlated with elevated LDH. Novel therapies should be investigated for their potential ability to overcome the high-risk features in MZL. Our data reinforce the importance of obtaining biopsies at relapse or progression, particularly in patients with baseline high Ki-67 and increased LCs, given their increased risk for HT.
Source: Blood Cancer Journal
Authors: Natalie S. Grover, Kaitlin Annunzio, Marcus Watkins, Pallawi Torka, Reem Karmali, Andrea Anampa-Guzmán, Timothy S. Oh, Heather Reves, Montreh Tavakkoli, Emily Hansinger, Beth Christian, Colin Thomas, Stefan K. Barta, Praveen Ramakrishnan Geethakumari, Nancy L. Bartlett, Geoffrey Shouse, Adam J. Olszewski, Narendranath Epperla
Institutions: University of North Carolina at Chapel Hill, UNC Lineberger Comprehensive Cancer Center, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Washington University in St. Louis, Roswell Park Comprehensive Cancer Center, Memorial Sloan Kettering Cancer Center, Northwestern University, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, University of Pennsylvania, Thomas Jefferson University, City Of Hope National Medical Center, Brown University, University of Utah, Huntsman Cancer Institute
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,990
Funders: Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, AstraZeneca, Leukemia and Lymphoma Society, Gilead Sciences, Celgene, F. Hoffmann-La Roche, Regeneron Pharmaceuticals, Celldex Therapeutics, TG Therapeutics, Adaptive Biotechnologies, BeiGene, Incyte, Seagen, MorphoSys, Ipsen, Genentech, Kite Pharma, Pharmacyclics, National Cancer Institute, Daiichi Sankyo Europe
Award: Cancer Center Support Grant
OpenAlex ID: W4403515114