Results from a retrospective study, published in the American Journal of Surgical Pathology, suggest that prognostic markers may be different in patients with SOX11-negative compared with SOX11-positive mantle cell lymphoma. 

Mantle cell lymphoma is a B-cell non-Hodgkin lymphoma with a typically aggressive clinical course. Median overall survival (OS) in this disease is relatively short (ie, 3-5 years), although more indolent disease has been observed in a subset of patients.

SOX11, which is often overexpressed at both the protein and RNA levels in mantle cell lymphoma, has been suggested as an oncogene in this disease, and as a predictor of patient outcome. However, there is conflicting evidence from studies involving small cohorts of patients with SOX11-negative disease regarding whether SOX11 status is a prognostic factor in mantle cell lymphoma.

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In this retrospective study, the clinicopathologic features of 221 patients with mantle cell lymphoma and immunohistochemical verification of SOX11 status included in a database from the MD Anderson Cancer Center, Houston, Texas, from January 1, 2004 to December 31, 2016 were assessed. Of these patients, 75 (34%) and 146 (66%) had SOX11-negative and SOX11-positive mantle cell lymphoma, respectively.

The median OS of patients with SOX11-negative mantle cell lymphoma was 36.4 months, which was not significantly different from patients with SOX11-positive mantle cell lymphoma (P =.63). Although the overall clinicopathologic features of SOX11-negative and SOX11-positive disease were similar, some differences were observed. For example, the frequencies of leukemic nonnodal disease, classic morphology, and expression of CD23 and CD200 were higher in SOX11-negative disease, and the Ki67 index was lower. While high Ki67 and blastoid/pleomorphic morphology were negative prognostic factors for patients with either SOX11-negative or SOX11-positive disease (P <.05), a high Mantle Cell Lymphoma International Prognostic Index (MIPI) predicted shorter survival in patients with SOX11-negative (P <.0001), but not those with SOX11-positive (P =.09), disease. In addition, nodal involvement and stage III/IV disease were predictors of shorter survival in patients with SOX11-positive disease (P =.03 and P =.04, respectively) but in those with SOX11-negative disease (P =.88 and P =.74, respectively). 

“The results of this study suggest that we may need to use different prognostic factors when assessing patients with SOX11-negative versus SOX11-positive mantle cell lymphoma: Ki67, morphology, and MIPI for SOX11-negative mantle cell lymphoma; Ki67, morphology, nodal involvement, and stage for SOX11-positive mantle cell lymphoma,” the authors wrote in conclusion. 


  1. Xu J, Wang L, Li J, Saksena A, et al. SOX11-negative mantle cell lymphoma: clinicopathologic and prognostic features of 75 patients [published online February 12, 2019]. Am J Surg Pathol. doi: 10.1097/PAS.0000000000001233