The modified International Prognostic Index can predict the outcome of localized primary intestinal lymphoma of both extranodal marginal zone B-cell and diffuse large B-cell histologies

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Abstract
Summary. We have previously reported on the efficacy of a modified International Prognostic Index (MIPI) in predicting the outcome of patients with primary gastric lymphoma. This prompted the retrospective analysis of a large series of patients with primary intestinal lymphoma (PIL) of both diffuse large B‐cell (DLCL) and low‐grade (extranodal marginal zone B‐cell lymphoma, MZL) histology. Clinical records of 122 patients with localized primary intestinal lymphoma of MZL (n=35) and DLCL (n=87) histology, confirmed by an ad hoc expert panel of pathologists, were reviewed. Forty‐nine patients were treated with single therapy, while 72 received combined‐modality treatment, which included surgery followed by a short‐term chemotherapy. MIPI was included in a multivariate prognostic analysis for overall survival (OS) and event‐free survival (EFS). Sixty‐five patients (75%) with DLCL and 22 with MZL(65%) achieved complete remission. After a median follow‐up of 42 months (range 6–163 months), 5‐year estimates of OS and EFS were 68% and 50% for DLCL and 65% and 26% for MZL. OS varied according to MIPI, from, respectively, 86% and 87% for DLCL and MZL patients with 0–1 risk factor to 50% and 32% for patients with > 1 risk factor (P=0·01 and P=0·02). Similar results were obtained for EFS. Cox regression analysis showed an unfavourable MIPI to be the only independent predictor of shorter EFS. This retrospective study shows that stage‐MIPI can be a reliable prognostic indicator for PIL of both low‐grade MZL and diffuse large B‐cell histology, enabling the early identification of patients at higher risk of failure.