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Wagle L, Regmi DR, Adhikari S, Basnyat P, Kalla A. Splenic Marginal Zone Lymphoma in a Patient With Antiphospholipid Syndrome Treated With Rituximab: A Case Report. Cureus 2024; 16:e55374. [PMID: 38562339 PMCID: PMC10983820 DOI: 10.7759/cureus.55374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Splenic marginal zone lymphoma (SMZL) usually presents with splenomegaly or symptoms related to cytopenia. We report a case of a 56-year-old female with previously diagnosed antiphospholipid syndrome (APS) on warfarin therapy who initially presented with abdominal pain and was found to have massive splenomegaly and splenic infarction on CT imaging. Initial clinical presentations and imaging findings were attributed to the subtherapeutic coagulation profile. The patient was later diagnosed with SMZL following workup for pancytopenia including bone marrow biopsy, flow cytometry, and PET scan. Cytopenias, splenomegaly, and abnormal metabolic activity in the spleen on the PET scan improved after treatment with four cycles of weekly rituximab. Our report presents a case of a patient with longstanding APS presenting with splenic infarction and pancytopenia who was subsequently diagnosed with SMZL and successfully treated with rituximab.
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Affiliation(s)
- Laxman Wagle
- Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, USA
| | | | - Samaj Adhikari
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | | | - Abhishek Kalla
- Hematology and Oncology, Ascension Saint Agnes Hospital, Baltimore, USA
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2
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Yang Z, Liu L, Leng K, Shi G. Time Trend Analysis of Splenectomy for Splenic Marginal Zone Lymphoma: Declining Surgery, Promising Survival. Ann Surg Oncol 2023; 30:7206-7216. [PMID: 37516724 DOI: 10.1245/s10434-023-13968-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/03/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND The purpose of current study was to examine the incidence, characteristics, treatment, and survival of splenic marginal zone lymphoma (SMZL). METHODS Using SEER-18 database, patients diagnosed with SMZL between 2000 and 2018 were included. Effect of splenectomy on survival was evaluated after balancing the confounding factors by propensity score matching. Rates of splenectomy and 1-year relative survival were calculated for each year. A logistic regression model identified factors related to splenectomy, and a Cox regression model assessed factors linked to overall survival (OS). RESULTS A total of 2790 patients with SMZL were analyzed. The majority were older than 60 years, female, and white. The age-adjusted incidence of SMZL was 0.17/100,000 person-years, with higher incidence in males. Incidence increased by 0.68%/year and peaked at 80-84 years for both genders. The SMZL-specific survival rates at 3 and 5 years were 89.6% and 85.3%, respectively. Meanwhile, the relative survival rates for the same periods were 88.6% and 85.9%, respectively. Splenectomy patients were more likely to be younger, male, and diagnosed with early-stage disease. Despite the decreasing utilization rate of splenectomy from 59.4% in 2000 to 16.2% in 2018, the 1-year relative survival rate remained relatively stable with minor fluctuations over time. Whether or not the patient underwent splenectomy was not found to be a significant prognostic indicator for OS. CONCLUSIONS Our study demonstrated a decreasing use of splenectomy but a relatively stable survival in patients with SMZL, highlighting the urgency to better understand the role of splenectomy and its associated outcomes.
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Affiliation(s)
- Zhen Yang
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, People's Republic of China
- Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China
| | - Lianshuang Liu
- Department of Infectious Diseases, Qingdao Women's and Children's Hospital, Qingdao University, Qingdao, People's Republic of China
| | - Kaiming Leng
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, People's Republic of China.
- Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China.
| | - Guangjun Shi
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, People's Republic of China.
- Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, People's Republic of China.
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3
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Meng M, Riera CA, Mosquera J, Parikh HR, Singh A. Atypical diffuse large B-cell lymphoma, primary splenic lymphoma variant; a case report. Int J Surg Case Rep 2023; 111:108861. [PMID: 37769409 PMCID: PMC10539923 DOI: 10.1016/j.ijscr.2023.108861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary splenic lymphoma (PSL) is characterized by lymphoma involvement confined to the spleen and hilar lymph nodes, without evidence of liver involvement or other sites. This condition is extremely uncommon, accounting for approximately 1 % of non- Hodgkin lymphomas (NHLs) and <2 % of all lymphomas. Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype of both PSLs and all NHLs. DLBCL encompasses an aggressive heterogeneous entity with distinct morphological variants. CASE PRESENTATION A 68 year-old gentleman presented to the office with a 10-month history of vague left sided upper abdominal pain. Clinical examination revealed a tender left upper quadrant, evidenced with splenomegaly on radiological evaluation. The patient proceeded with a splenectomy with subsequent pathological and immunohistochemical analysis, confirming a final diagnosis of germinal center type DLBCL. CLINICAL DISCUSSION Primary splenic DLBCL is a rare variant of DLBCL, characterized by exclusive involvement of the spleen. It requires a comprehensive diagnostic evaluation to exclude lymphoma involvement in other organs and lymph nodes. Splenectomy followed by appropriate adjuvant therapy has been demonstrated as the definitive treatment strategy. This case report emphasizes the importance of considering primary splenic DLBCL as a differential diagnosis in patients presenting with splenomegaly and highlights the significance of multidisciplinary collaboration for accurate diagnosis and optimal management of this uncommon entity. CONCLUSION Primary Splenic DLBCL, an exceptionally rare B-Cell neoplasm variant, requires precise diagnosis due to its unique splenic involvement. Splenectomy's efficacy, adjuvant therapy, multidisciplinary collaboration, and ongoing research are crucial for optimal management.
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Affiliation(s)
- Muzi Meng
- General Surgery, BronxCare Health System, Bronx, NY, USA; School of Medicine, American University of the Caribbean, Cupecoy, St. Maarten, the Netherlands
| | - Cesar A Riera
- General Surgery, BronxCare Health System, Bronx, NY, USA.
| | - Jorge Mosquera
- General Surgery, BronxCare Health System, Bronx, NY, USA
| | - Harsh R Parikh
- General Surgery, BronxCare Health System, Bronx, NY, USA; School of Medicine, St. George's University, Grenada
| | - Ajit Singh
- General Surgery, BronxCare Health System, Bronx, NY, USA
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4
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Junlén H, Sonnevi K, Lindén O, Hellström M, Scivetti MV, Olsson M, Tufvesson I, Johansson A, Wahlin BE. Splenic marginal zone lymphoma in Sweden 2000-2020: Increasing rituximab use and better survival in the elderly. EJHAEM 2023; 4:647-655. [PMID: 37601869 PMCID: PMC10435707 DOI: 10.1002/jha2.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 08/22/2023]
Abstract
The treatment of splenic marginal zone lymphoma is debated: splenectomy (the old standard-of-care) is better than chemotherapy but maybe not better than rituximab-containing treatment. We examined all 358 patients diagnosed with splenic marginal zone lymphoma in Sweden 2000-2020. The median overall survival was 11.0 years. The median age was 73 years; 61% were women. Age was the only independently prognostic clinical characteristic. Eighty-six patients were started on wait-and-watch, 90 rituximab monotherapy, 47 rituximab-chemotherapy, 88 splenectomy, 37 chemotherapy, and 10 both systemic therapy and splenectomy. Overall survival was inferior in patients treated with chemotherapy, but equal in patients treated with rituximab, rituximab-chemotherapy and splenectomy. Patients treated with both systemic therapy and splenectomy showed good outcome, suggesting that surgery can be safely reserved for nonresponders. After adjustment for age, survival did not differ between patients started on wait-and-watch and those treated with splenectomy or rituximab-containing therapy. Over time, rituximab use and survival increased in patients ≥73 years. This is, to our knowledge, the largest population-based study of splenic marginal zone lymphoma patients treated with upfront rituximab. We conclude that wait-and-watch remains the most reasonable option in asymptomatic splenic marginal zone lymphoma patients. Symptomatic patients should be offered single-agent rituximab in first line.
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Affiliation(s)
- Henna‐Riikka Junlén
- Division of HematologyDepartment of MedicineHuddingeKarolinska InstitutetStockholmSweden
- Medical Unit HematologyKarolinska University HospitalStockholmSweden
| | - Kristina Sonnevi
- Division of HematologyDepartment of MedicineHuddingeKarolinska InstitutetStockholmSweden
- Medical Unit HematologyKarolinska University HospitalStockholmSweden
| | - Ola Lindén
- Department of OncologySkåne University HospitalLundSweden
| | - Mats Hellström
- Department of ImmunologyGenetics and PathologyUppsala UniversityUppsalaSweden
| | | | - Mikael Olsson
- Section of HematologyDepartment of Internal MedicineHallands Sjukhus VarbergVarbergSweden
| | - Ida Tufvesson
- Division of HematologyDepartment of MedicineRyhov County HospitalJönköpingSweden
| | | | - Björn Engelbrekt Wahlin
- Division of HematologyDepartment of MedicineHuddingeKarolinska InstitutetStockholmSweden
- Medical Unit HematologyKarolinska University HospitalStockholmSweden
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5
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Muntañola A, Villalobos MT, González-Villambrosia S, Rodríguez-Salazar MJ, Jiménez-Ubieto A, Bastidas-Mora G, Córdoba R, Infante M, Vidal MJ, Díaz FJ, Baile M, Bastos-Oreiro M, Panizo C, Sancho JM, Navarro B, García T, Escoda L, Abrisqueta P, Terol MJ, de Campo R, Mozas P, López-Guillermo A, Salar A, Montalbán C. Low-risk HPLLs/ABC score patients with splenic marginal zone lymphoma can be safely managed without treatment: Results from a prospective Spanish study. Br J Haematol 2023; 202:776-784. [PMID: 37386877 DOI: 10.1111/bjh.18912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023]
Abstract
The aims of our study were to analyse compliance with the 2014 GELTAMO SMZL Guidelines, in patients with splenic marginal zone lymphoma (SMZL), and to evaluate the outcome according to the HPLLs/ABC-adapted therapeutic strategy. Observational prospective multicenter study of 181 SMZL patients diagnosed between 2014 and 2020. Lymphoma-specific survival (LSS), composite event-free survival (CEFS) and response rates were assessed. 57% of the 168 patients included in the analysis followed the Guidelines. The overall response rate was higher in the rituximab chemotherapy and in the rituximab arms compared with the splenectomy arm (p < 0.001). The 5-year overall survival was 77% and the 5-year LSS of 93%. There were no differences in the 5-year LSS according to the treatment received (p = 0.68). The 5-year CEFS in the overall series was 45%, and there were significant differences between scores A and B (p = 0.036). There were no significant differences when comparing LSS and progression-free survival in patients treated with rituximab or rituximab chemotherapy at diagnosis or after observation. Our data support HPLLs/ABC score as a practical tool for the management of SMZL, observation as the best approach for patients in group A and rituximab as the best treatment for group B.
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Affiliation(s)
- Ana Muntañola
- Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | | | | | | | | | | | - Raúl Córdoba
- Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria IIS-FDJ, Madrid, Spain
| | | | | | | | - Mónica Baile
- Complejo Asistencial Universitario de Salamanca/IBSAL, Salamanca, Spain
| | - Mariana Bastos-Oreiro
- Hospital Universitario Gregorio Marañón/Gregorio Marañón Health Institute (IiSGM), Madrid, Spain
| | | | - Juan Manuel Sancho
- ICO-Hospital Germans Trias i Pujol-ICO Badalona, Badalona, Barcelona, Spain
| | | | - Tomás García
- Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
| | | | | | | | | | - Pablo Mozas
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Carlos Montalbán
- Departamento de Patología e Investigación Traslacional, Fundación MD Anderson, Madrid, Spain
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6
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Peters A, Keating MM, Nikonova A, Doucette S, Prica A. Management of Marginal Zone Lymphoma: A Canadian Perspective. Curr Oncol 2023; 30:1745-1759. [PMID: 36826096 PMCID: PMC9955247 DOI: 10.3390/curroncol30020135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Marginal zone lymphomas (MZL) are a rare, heterogenous group of lymphomas, accounting for 5-17% of indolent non-Hodgkin lymphomas in the western world. They can be further divided into three subtypes: extranodal MZL, splenic MZL, and nodal MZL. These subtypes differ in clinical presentation and behavior, which influences how they are managed. There is currently no standard of care for the treatment of MZL, owing to the difficulty in conducting phase 3 randomized trials in MZL, and the fact that there are limited data on the efficacy of therapy in individual subtypes. Treatment practices are thus largely borrowed from other indolent lymphomas and are based on patient and disease characteristics, as well as access to therapy. This review summarizes the Canadian treatment landscape for MZL and how these therapies may be sequenced in practice.
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Affiliation(s)
- Anthea Peters
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
- Correspondence:
| | - Mary-Margaret Keating
- Division of Hematology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Anna Nikonova
- Division of Hematology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | | | - Anca Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
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7
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Muacevic A, Adler JR, Wasson A, Farmand F. Incidental Splenic Marginal Zone Lymphoma With Extreme Macrocytosis After Hydroxyurea Use: A Case Report. Cureus 2023; 15:e33462. [PMID: 36751210 PMCID: PMC9899520 DOI: 10.7759/cureus.33462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/07/2023] Open
Abstract
Splenic marginal zone lymphoma (SMZL) is a low-grade mature B-cell lymphoma that typically presents in the form of splenomegaly and lymphocytosis. The diagnosis is traditionally made through splenic histology, the presence of circulating villous lymphocytes, or bone marrow biopsy. Its treatment can be in the form of chemotherapy, such as rituximab, or active surveillance. This case presentation discusses a 76-year-old female with a long history of hydroxyurea use for an unknown reason presenting with atypical symptoms requiring bone marrow biopsy to diagnose SMZL. This unique case demonstrates the importance of further research and studies into atypical SMZL presentations and hydroxyurea's potential in precipitating secondary malignancies.
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8
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Muacevic A, Adler JR, Farkouh CS, Tango T, Bereka L, Ul Ain H, Belay NF, Farkouh M, Ali Khan Q. The Diagnostic Dilemma of Splenic Non-Hodgkin's Lymphoma and Splenic Abscess: A Narrative Review. Cureus 2022; 14:e31944. [PMID: 36582581 PMCID: PMC9794911 DOI: 10.7759/cureus.31944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Non-Hodgkin's lymphoma (NHL) is a lymphoproliferative disorder that principally displays lymph node involvement but can also spread to extranodal sites such as the spleen. Primary splenic NHL arises in the spleen and, due to its atypical presentation, can sometimes present similarly to other splenic conditions. This review aims to highlight how primary splenic NHL can be effectively differentiated from other splenic conditions, such as splenic abscesses. PubMed, MEDLINE, Scopus, Google, and Google Scholar were used to identify articles mainly focused on splenic non-Hodgkin's lymphoma and splenic abscess. The search was limited to articles published from January 2005 to November 2022. Of the 229 total articles amassed, only 34 were selected and narratively reviewed. From a thorough review of the current literature, it is evident that splenic NHL displays a similar clinical picture to other splenic conditions, namely splenic abscesses. One cannot easily differentiate between the two conditions, both clinically and via diagnostic imaging. Lymphadenopathy, a hallmark sign of nodal NHL, may or may not be present in splenic NHL. Ultimately, splenectomy with biopsy and immunohistochemical staining (IHC) may be required to confirm the diagnosis. In cases of suspected splenic NHL or splenic abscess with little-to-no symptomatic improvement after medication administration, splenectomy followed by histopathological examination may be required for a definitive diagnosis and proper treatment.
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9
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Roche KC, DeRosa PA, Liu ML, Nava VE, Aggarwal A. Refractory Splenic Marginal Zone Lymphoma Responsive to Combination Venetoclax and Bortezomib (Velcade) (V2) Therapy. Curr Oncol 2022; 29:4117-4124. [PMID: 35735437 PMCID: PMC9221762 DOI: 10.3390/curroncol29060328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Standard treatment regimens for the management of patients with refractory splenic marginal zone lymphoma (SMZL) are currently unavailable. Here, we report a case of SMZL, which, after failing multiple therapeutics, demonstrated an impressive clinical response to combined Venetoclax and Velcade (V2), a treatment combination currently being investigated in the setting of refractory multiple myeloma. We also report a unique histopathology and mutational profile that may have important implications for the characterization and prognosis of SMZL.
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Affiliation(s)
- Kyle C. Roche
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA; (K.C.R.); (A.A.)
| | - Peter A. DeRosa
- Department of Pathology, The University of Maryland Medical Center, Baltimore, MD 21201, USA
- Correspondence:
| | - Min-Ling Liu
- Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA; (M.-L.L.); (V.E.N.)
- Department of Pathology, Veterans Health Administration Medical Center, Washington, DC 20422, USA
| | - Victor E. Nava
- Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA; (M.-L.L.); (V.E.N.)
- Department of Pathology, Veterans Health Administration Medical Center, Washington, DC 20422, USA
| | - Anita Aggarwal
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA; (K.C.R.); (A.A.)
- Department of Pathology, Veterans Health Administration Medical Center, Washington, DC 20422, USA
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10
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Anti-CD20 rechallenge with ofatumumab in relapsed/refractory splenic marginal zone lymphoma: the MORE trial. Blood Adv 2022; 6:5356-5359. [PMID: 35613463 PMCID: PMC9631708 DOI: 10.1182/bloodadvances.2022007138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
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Jeong SH. Treatment of indolent lymphoma. Blood Res 2022; 57:120-129. [PMID: 35483936 PMCID: PMC9057664 DOI: 10.5045/br.2022.2022054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Treatment of indolent lymphoma has improved significantly in recent decades since the advent of rituximab (anti-CD20 monoclonal antibody). Although, some patients with limited disease can be cured with radiation therapy alone, most patients experience disease progression and recurrence during follow-up despite early initiation of treatment. Thus, watch-and-wait is still regarded the standard for asymptomatic patients. Patients with indolent lymphoma have a significant heterogeneity in terms of tumor burden, symptoms (according to anatomical sites) and the need for instant therapy. Therefore, the initiation of treatment and treatment option should be decided with a clear goal in each patient according to the need for therapy and clinical benefits with the chosen treatment. In this review, we cover the current treatment of follicular lymphoma and marginal zone lymphoma.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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12
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Castelli R, Balzarotti M, Salvi E, Simona Rossi R, Lambertenghi Deliliers G, Bergamaschini L, Gidaro A. Risk-tailored treatment of splenic marginal zone lymphoma. Anticancer Drugs 2022; 33:e36-e42. [PMID: 34407041 DOI: 10.1097/cad.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Splenic marginal zone lymphoma (SMZL) is a rare lymphoproliferative disease involving B-cells and affecting elderly patients. SMZL plague peripheral blood and bone marrow, spleen. Lymph nodes are generally spared. SMZL is due to a protracted antigen stimulation of B lymphocytes and of microenvironment leading B-cell to polyclonal and then oligoclonal/monoclonal growth, promoting lymphoproliferation. Integration of the NOTCH2 and NFk-B signaling has been recently identified as the primary mechanism of neoplastic proliferation in SMZL. In total 20% of cases carry mutations in NOTCH2. Although SMZL has an indolent course, progression to diffuse large B-cell lymphoma occurs in about 10-15% of patients. Establishing the prognosis is a key step in disease management, depending on both individual risk and patients' health status. This review discusses tailored treatment of SMZL patients. Progression risk factors include nodal and extra-nodal involvement, peripheral lymphocytosis, anemia and thrombocytopenia. Patients with two or more score points have a median survival of <5 years. Watch and wait strategy is appropriate in low-risk and asymptomatic patients, whereas treatment of symptomatic patients ranges from splenectomy to rituximab monotherapy or associated with chemotherapy.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Disease Progression
- Hepatitis B/pathology
- Hepatitis C/epidemiology
- Hepatitis C/pathology
- Humans
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/epidemiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Lymphoma, Large B-Cell, Diffuse/physiopathology
- NF-kappa B/metabolism
- Neoplasm Staging
- Precision Medicine/methods
- Receptor, Notch2/genetics
- Receptor, Notch2/metabolism
- Receptors, Antigen, B-Cell/genetics
- Receptors, Antigen, B-Cell/immunology
- Risk Assessment
- Risk Factors
- Signal Transduction
- Splenectomy
- Splenic Neoplasms/drug therapy
- Splenic Neoplasms/epidemiology
- Splenic Neoplasms/pathology
- Splenic Neoplasms/surgery
- Tumor Microenvironment/physiology
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Affiliation(s)
- Roberto Castelli
- Università degli studi di Sassari, scienze mediche chirurgiche e sperimentali
| | - Monica Balzarotti
- Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano
| | - Emanuele Salvi
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
| | - Roberta Simona Rossi
- Service of Pathology, ASST Fatebenefratelli-Sacco, Luigi Sacco, University Hospital Milano
| | | | - Luigi Bergamaschini
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan
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Rodrigues CD, Peixeiro RP, Viegas D, Chorão P, Couto ME, Gaspar CL, Fernandes JP, Alves D, Ribeiro LA, de Vasconcelos M P, Tomé AL, Badior M, Coelho H, Príncipe F, Chacim S, da Silva MG, Coutinho R. Clinical Characteristics, Treatment and Evolution of Splenic and Nodal Marginal Zone Lymphomas-Retrospective and Multicentric Analysis of Portuguese Centers. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e839-e844. [PMID: 34326035 DOI: 10.1016/j.clml.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Treatment of Splenic (SMZL) and Nodal (NMZL) Marginal Zone Lymphoma is not consensual. Histologic transformation (HT) to aggressive lymphoma is a poorly understood event, with an unfavorable outcome. OBJECTIVES Describe the clinical characteristics, treatment, outcomes and incidence of HT. METHODS Characteristics of patients with SMZL and NMZL consecutively diagnosed in 8 Portuguese centers were retrospectively reviewed. Endpoints were overall survival (OS), time to first systemic treatment (TTFST), frequency of HT and time to transformation (TTT). RESULTS This study included 122 SMZL and 68 NMZL, most of them received systemic treatment: 55.4% and 76.5%, respectively. Splenectomy was performed in 58.7% of patients with SMZL. Different treatment protocols were used. OS or TTFST did not differ significantly according to treatments. Given the small sample size, no conclusion can be made concerning the role of Rituximab in the treatment of NMZL and SMZL based in these results. HT was documented in 18 patients, mainly in SMZL, with a cumulative incidence at 5 years of 4.2%. We confirmed that age is a prognostic factor. CONCLUSION Randomized prospective trials are needed to standardize treatment in MZL. Patients with HT did appear to have shorter OS in comparison with those who did not experience HT (OS 5 years of 68.4% vs. 80.4%), but the number of HT was too small to reach statistical significance.
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Affiliation(s)
- Catarina Dantas Rodrigues
- Centro Hospitalar de Tondela-Viseu, Viseu, Portugal; Centro Hospitalar e Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal.
| | - Rita Pinho Peixeiro
- Centro Hospitalar e Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - Diana Viegas
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - M Eduarda Couto
- Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | | | | | | | | | | | | | | | | | | | - Sérgio Chacim
- Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | | | - Rita Coutinho
- Centro Hospitalar e Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
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14
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Vaughn JL, Pinheiro LC, Olszewski A, Epperla N. Survival of patients with marginal zone lymphoma in the United States: A population-based cohort study (2000 to 2017). Am J Hematol 2021; 96:E123-E126. [PMID: 33476433 DOI: 10.1002/ajh.26103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/09/2022]
Affiliation(s)
- John L. Vaughn
- Division of Hematology & Medical Oncology Weill Cornell Medicine New York New York
- Clinical Epidemiology & Health Services Research Program Weill Cornell Medicine New York New York
| | - Laura C. Pinheiro
- Division of General Internal Medicine Weill Cornell Medicine New York New York
| | - Adam Olszewski
- Division of Hematology Brown University Providence Rhode Island
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15
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Lumish M, Falchi L, Imber BS, Scordo M, von Keudell G, Joffe E. How we treat mature B-cell neoplasms (indolent B-cell lymphomas). J Hematol Oncol 2021; 14:5. [PMID: 33407745 PMCID: PMC7789477 DOI: 10.1186/s13045-020-01018-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022] Open
Abstract
Mature B cell neoplasms, previously indolent non-Hodgkin lymphomas (iNHLs), are a heterogeneous group of malignancies sharing similar disease courses and treatment paradigms. Most patients with iNHL have an excellent prognosis, and in many, treatment can be deferred for years. However, some patients will have an accelerated course and may experience transformation into aggressive lymphomas. In this review, we focus on management concepts shared across iNHLs, as well as histology-specific strategies. We address open questions in the field, including the influence of genomics and molecular pathway alterations on treatment decisions. In addition, we review the management of uncommon clinical entities including nodular lymphocyte-predominant Hodgkin lymphoma, hairy cell leukemia, splenic lymphoma and primary lymphoma of extranodal sites. Finally, we include a perspective on novel targeted therapies, antibodies, antibody-drug conjugates, bispecific T cell engagers and chimeric antigen receptor T cell therapy.
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Affiliation(s)
- Melissa Lumish
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Lorenzo Falchi
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Brandon S Imber
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Michael Scordo
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Gottfried von Keudell
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Erel Joffe
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA.
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16
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Broccoli A, Zinzani PL. How do we sequence therapy for marginal zone lymphomas? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:295-305. [PMID: 33275704 PMCID: PMC7727586 DOI: 10.1182/hematology.2020000157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Marginal zone lymphomas are indolent diseases. Overall survival rates are very good, but patients tend to relapse and may do so several times. The concept of treatment sequencing is therefore important and necessary to preserve adequate organ function and to avoid excessive toxicity, with the final goal of achieving long survival times. Systemic treatments and chemotherapy are considered to be an option in multiply relapsing disease, in cases that are in an advanced stage at presentation or relapse, and in cases where initial local treatments lack efficacy. Targeted agents and new drugs can provide chemotherapy-free alternatives in heavily pretreated patients.
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MESH Headings
- Aged
- Anti-Bacterial Agents/therapeutic use
- Antineoplastic Agents/therapeutic use
- Disease Management
- Humans
- Immunotherapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/radiotherapy
- Lymphoma, B-Cell, Marginal Zone/surgery
- Lymphoma, B-Cell, Marginal Zone/therapy
- Male
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Neoplasm Recurrence, Local/therapy
- Rituximab/therapeutic use
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Affiliation(s)
- Alessandro Broccoli
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; and Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale. Università degli Studi, Bologna, Italy
| | - Pier Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; and Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale. Università degli Studi, Bologna, Italy
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17
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Mulas O, Caocci G, Dessì D, Mantovani D, Moi G, Cabras MG, La Nasa G. Rituximab Monotherapy or in Combination with Bendamustine Is Not Inferior to Rituximab-CHOP Regimen in the Treatment of Patients with Splenic Marginal Zone Lymphoma in the Real Life. Acta Haematol 2020; 144:322-326. [PMID: 32892194 DOI: 10.1159/000509596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/20/2020] [Indexed: 11/19/2022]
Abstract
Splenic marginal zone lymphoma (SMZL) is a rare lymphoma belonging to the marginal zone lymphoproliferative disorders. Usually, SMZL occurs with indolent presentation and, when required, the standard of care is represented by rituximab-based regimens. No direct comparison of different rituximab-based combinations and polychemotherapy regimens has been conducted to date. In a monocentric cohort of 68 SMLZ patients, we showed that rituximab in monotherapy or in combination with bendamustine, compared with rituximab associated with the polychemotherapy cycle cyclophosphamide, hydroxydaunorubicin, vincristine and prednisolone (CHOP), resulted in a higher 5-year progression-free survival (91.3 ± 9% and 75 ± 15.7% vs. 30.8 ± 12.1%, p < 0.001). Platelets at diagnosis <100 ×109/L (p = 0.034, HR = 4.3) and transformation into diffuse large B-cell lymphoma (p = 0.031, HR = 4.3) were associated with a lower overall survival.
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Affiliation(s)
- Olga Mulas
- Ematologia e CTMO, Ospedale Businco, AOB, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Ematologia e CTMO, Ospedale Businco, AOB, Cagliari, Italy,
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy,
| | - Daniela Dessì
- Ematologia e CTMO, Ospedale Businco, AOB, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Daniela Mantovani
- Ematologia e CTMO, Ospedale Businco, AOB, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Giulia Moi
- Ematologia e CTMO, Ospedale Businco, AOB, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Maria Giuseppina Cabras
- Ematologia e CTMO, Ospedale Businco, AOB, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Ematologia e CTMO, Ospedale Businco, AOB, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
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18
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Ishiguro K, Sasaki Y, Takagi Y, Niinuma T, Suzuki H, Tokino T, Hayashi T, Takahashi T, Igarashi T, Matsuno Y. Aggressive variant of splenic marginal zone lymphoma characterized using a cancer panel test and treated with rituximab-containing chemotherapy: A case report. Medicine (Baltimore) 2020; 99:e21938. [PMID: 32871937 PMCID: PMC7458248 DOI: 10.1097/md.0000000000021938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Aggressive variant of splenic marginal zone lymphoma (AV-SMZL) is a very rare disease that is often associated with TP53 mutations and has a poor prognosis. On the other hand, recent advances in genome sequencing techniques enable us to understand the molecular characteristics of rare cancers such as AV-SMZL. Here we present a case of AV-SMZL analyzed using a genetic test. PATIENT CONCERNS A 66-year-old woman was admitted with splenomegaly and lymphocytosis. Computed tomography revealed marked splenomegaly without lymphadenopathy in any other areas. The serum soluble interleukin-2 receptor (sIL-2R) level was significantly elevated. Peripheral and bone marrow blood tests showed an increase in abnormal lymphocytes. DIAGNOSIS A splenectomy revealed an SMZL pattern with increased numbers of large cells and mitotic cells and a high Ki-67 positivity rate, which led to a diagnosis of AV-SMZL. Although TP53 mutation was not detected, mutations in NOTCH2, NCOA4, PTEN, EPHA3, and KMT2D were identified. Among these, the mutations in NCOA4, PTEN, and EPHA3 were novel pathogenic mutations in SMZL, which suggests they may be related to the aggressiveness and persistence of the disease. INTERVENTIONS The patient was administered a rituximab-containing regimen and rituximab-maintenance therapy. OUTCOMES The patient continues to exhibit a complete response. LESSONS This is a case of AV-SMZL in which a cancer panel test successfully detected genetic alterations that are potentially associated with its pathogenesis. These findings suggest that genetic analysis is useful for making diagnoses as well as for determining treatment strategies in AV-SMZL.
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Affiliation(s)
- Kazuya Ishiguro
- Department of Hematology, Tenshi Hospital
- Department of Molecular Biology, Sapporo Medical University School of Medicine
| | - Yasushi Sasaki
- Center for Medical Education, Sapporo Medical University
| | | | - Takeshi Niinuma
- Department of Molecular Biology, Sapporo Medical University School of Medicine
| | - Hiromu Suzuki
- Department of Molecular Biology, Sapporo Medical University School of Medicine
| | - Takashi Tokino
- Department of Medical Genome Sciences, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine
| | - Toshiaki Hayashi
- Department of Hematology, Teine Keijinkai Hospital, Sapporo, Japan
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19
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Florindez JA, Alderuccio JP, Reis IM, Lossos IS. Splenic marginal zone lymphoma: A US population‐based survival analysis (1999‐2016). Cancer 2020; 126:4706-4716. [DOI: 10.1002/cncr.33117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Jorge A. Florindez
- Division of Hospital Medicine Miller School of Medicine University of Miami Miami Florida
| | - Juan Pablo Alderuccio
- Divison of Hematology Sylvester Comprehensive Cancer Center Miller School of Medicine University of Miami Miami Florida
| | - Isildinha M. Reis
- Division of Biostatistics Department of Public Health Sciences Miller School of Medicine University of Miami Miami Florida
- Biostatistics and Bioinformatics Core Resource Sylvester Comprehensive Cancer Center Miller School of Medicine University of Miami Miami Florida
| | - Izidore S. Lossos
- Divison of Hematology Sylvester Comprehensive Cancer Center Miller School of Medicine University of Miami Miami Florida
- Department of Molecular and Cellular Pharmacology University of Miami Miami Florida
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20
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de Pádua Covas Lage LA, Dos Santos FFC, Levy D, Moreira FR, Couto SCF, Culler HF, de Oliveira Costa R, Rocha V, Pereira J. Risk adapted approach: How to treat splenic marginal zone lymphoma in resource-poor settings? - The real-life experience of a Brazilian cancer treatment center. BMC Cancer 2020; 20:717. [PMID: 32746790 PMCID: PMC7397612 DOI: 10.1186/s12885-020-07204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Splenic marginal zone lymphoma (SMZL) is a rare lymphoid B-cell malignant neoplasm with primary involvement of the spleen. It is a chronic disease, of indolent behavior and prolonged survival. However, 25% of cases have higher biological aggressiveness, propensity for histological transformation to high grade B-cell non-Hodgkin lymphoma and shortened survival. Recognition of these cases of reserved outcome is important for selecting a risk-adapted therapeutic approach in a resource-poor settings. Methods We described clinical and epidemiological characteristics, survival analysis and prognostic factors in a retrospective cohort of 39 SMZL patients, treated in Latin America. Results We observed a predominance of female (71.8%), median age of 63 years and higher incidence of B symptoms (56.4%) and extra-splenic involvement (87.1%) than in European and North-American series. With a median follow-up of 8.7 years (0.6-20.2 years), estimated 5-year overall survival (OS) and progression-free survival (PFS) were 76.9% and 63.7%, respectively. Factors with adverse prognostic impact on OS and PFS were Hb < 100 g/L, platelet count < 100 x 109/L, albumin < 3.5 g/dL, LDH > 480 U/L and high-risk Arcaini and SMZL/WG scores. Despite a relative low number of patients, no superiority was observed among the therapeutic regimens used including rituximab monotherapy, splenectomy and cytotoxic chemotherapy. Conclusion Therefore, in resource-poor settings, where access to immunotherapy is not universal for all SMZL patients, we suggest that first-line should consist on rituximab therapy for elderly patients or with high surgical risk or with at least 1 risk factor identified in our study. Remainders can be safely managed with splenectomy.
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Affiliation(s)
- Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy and Cell Therapy of Medicine School, Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Sao Paulo University (FMUSP), Rua Maranhão, número 300, apartamento 13 - São Caetano do Sul, São Paulo (SP), 09541-000, Brazil.
| | | | - Débora Levy
- Department of Hematology, Hemotherapy and Cell Therapy of Medicine School, Laboratory of Medical Investigation 19 (LIM-19), Sao Paulo University (FMUSP), São Paulo, Brazil
| | - Frederico Rafael Moreira
- Statistical, Department of Hematology, Hemotherapy and Cell Therapy of Medicine School, Sao Paulo University (FMUSP), São Paulo, Brazil
| | | | - Hebert Fabrício Culler
- Department of Hematology, Hemotherapy and Cell Therapy of Medicine School, Sao Paulo University (FMUSP), São Paulo, Brazil
| | - Renata de Oliveira Costa
- Department of Hematology and Hemotherapy, Centro Universitário Lusíadas, Santos, Sao Paulo, Brazil
| | - Vanderson Rocha
- Department of Hematology, Hemotherapy and Cell Therapy of Medicine School, Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Sao Paulo University (FMUSP), Rua Maranhão, número 300, apartamento 13 - São Caetano do Sul, São Paulo (SP), 09541-000, Brazil.,Pró-Sangue Foundation (Sao Paulo Blood Bank), São Paulo, Brazil.,Churchill Hospital, Oxford University, Oxford, UK
| | - Juliana Pereira
- Department of Hematology, Hemotherapy and Cell Therapy of Medicine School, Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Sao Paulo University (FMUSP), Rua Maranhão, número 300, apartamento 13 - São Caetano do Sul, São Paulo (SP), 09541-000, Brazil
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21
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Zucca E, Arcaini L, Buske C, Johnson PW, Ponzoni M, Raderer M, Ricardi U, Salar A, Stamatopoulos K, Thieblemont C, Wotherspoon A, Ladetto M. Marginal zone lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2019; 31:17-29. [PMID: 31912792 DOI: 10.1016/j.annonc.2019.10.010] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023] Open
Affiliation(s)
- E Zucca
- Division of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Oncology Research, Bellinzona, Switzerland
| | - L Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - C Buske
- Comprehensive Cancer Centre, University Hospital of Ulm, Ulm, Germany
| | - P W Johnson
- Cancer Research UK Centre, Southampton General Hospital, Southampton, UK
| | - M Ponzoni
- Vita-Salute San Raffaele University and Pathology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - M Raderer
- Internal Medicine I, Division of Oncology, Medical University Vienna, Vienna, Austria
| | - U Ricardi
- Department of Oncology, University of Turin, Turin, Italy
| | - A Salar
- Department of Hematology, Hospital del Mar, Barcelona, Barcelona, Spain
| | - K Stamatopoulos
- Institute of Applied Biosciences, CERTH, the Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - C Thieblemont
- Department of Hematology, APHP-Saint-Louis Hospital, University Paris-Diderot, Paris, France
| | - A Wotherspoon
- Department of Histopathology, The Royal Marsden Hospital, London, UK
| | - M Ladetto
- Division of Hematology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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22
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Robinson AC, Nachar VR. Successful rechallenge of rituximab following severe rituximab-induced acute thrombocytopenia in a patient with splenic marginal zone lymphoma. J Oncol Pharm Pract 2019; 26:1248-1253. [PMID: 31766968 DOI: 10.1177/1078155219890023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rituximab-induced acute thrombocytopenia (RIAT) is a relatively rare complication of rituximab treatment that has been infrequently reported in a number of patients with malignant lymphoma. Most commonly encountered in mantle cell lymphoma, the extent to which RIAT occurs in splenic marginal zone lymphoma is unknown. In this report, we describe a case of RIAT in a patient with splenic marginal zone lymphoma. Rituximab was safely rechallenged with increased premedications and slowed infusion rate. While the exact mechanism of this phenomenon has yet to be elucidated, diligent monitoring of platelet counts following rituximab infusion can be considered in high-risk patients to avoid potential adverse events. Split dose rituximab for high-risk patients may provide an alternative approach to improve patient safety.
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Affiliation(s)
- Adam C Robinson
- Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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23
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Leslie LA, Feldman TA, McNeill A, Timberg M, Iida H, Goy AH. Contemporary management of nodal and primary splenic marginal zone lymphoma. Expert Rev Hematol 2019; 12:1011-1022. [PMID: 31619091 DOI: 10.1080/17474086.2020.1681962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Marginal zone lymphoma (MZL) accounts for approximately 10% of all cases of non-Hodgkin lymphoma and includes 3 clinically distinct subtypes: extranodal (MALT), splenic (SMZL), and nodal (NMZL). Though commonly grouped in trials of iNHL the clinical behavior, molecular features, and response to therapy of MZL is distinct from other iNHL subtypes and varies among MZL subtypes.Areas covered: This review focuses on the contemporary management of NMZL and SMZL. Treatment with monoclonal antibodies, chemoimmunotherapy, BTK inhibitors, PI3K/mTOR inhibitors, Bcl2 inhibitors, lenalidomide, and CAR-T cell therapy will be covered.Expert opinion: In the era of targeted medicine, the need to develop MZL specific clinicogenetic models with prognostic and predictive value in both the frontline and relapsed/refractory setting is becoming increasingly apparent. Due to the relative rarity of each MZL subtype, the use of novel trial design with correlative studies is imperative to advance the field.
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Affiliation(s)
- Lori A Leslie
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
| | | | - Ann McNeill
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
| | - Mary Timberg
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
| | - Hoshiyuki Iida
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
| | - Andre H Goy
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
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24
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Kandil M, Alhashmi H, Alzahrani M, Alhejazi A, Motabi I, Dada R, Al-Mansour M, Sagheir A. Marginal Zone Lymphoma: Saudi Lymphoma Group's Clinical Practice Guidelines for Diagnosis, Management and Follow-up. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:202-208. [PMID: 31543745 PMCID: PMC6734739 DOI: 10.4103/sjmms.sjmms_97_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/15/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Magdy Kandil
- Oncology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Clinical Oncology Department, Cairo University, Giza, Egypt
| | - Hani Alhashmi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Central Region, Riyadh, Saudi Arabia
| | - Ibraheem Motabi
- Department of Adult Hematology and BMT, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Reyad Dada
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, Saudi Arabia
| | - Ahmed Sagheir
- Oncology Institute, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
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25
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Juárez-Salcedo LM, Castillo JJ. Lymphoplasmacytic Lymphoma and Marginal Zone Lymphoma. Hematol Oncol Clin North Am 2019; 33:639-656. [DOI: 10.1016/j.hoc.2019.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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26
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Liu Z, Markham M, Mandernach MW. Marginal zone lymphoma-associated antiphospholipid antibodies successfully treated with bendamustine rituximab. BMJ Case Rep 2019; 12:12/3/e224636. [PMID: 30872333 DOI: 10.1136/bcr-2018-224636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 46-year-old man presented with splenomegaly, abdominal adenopathy and profoundly elevated prothrombin time and partial thromboplastin time. He was diagnosed with marginal zone lymphoma (MZL) and small lymphocytic lymphoma, and the abnormal coagulation studies were secondary to the presence of a lupus anticoagulant. Optimal upfront therapy for MZL has not been established, and the incidence of antiphospholipid antibodies (APLA) in this patient population is rare. Following treatment with six cycles of bendamustine and rituximab with 2 years of rituximab maintenance, our patient remained in remission and his coagulation studies normalised. This report describes a case of successful treatment of APLA associated with MZL that resolved after treatment of the lymphoma.
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Affiliation(s)
- Ziyang Liu
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, Florida, USA
| | - Merry Markham
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, Florida, USA
| | - Molly W Mandernach
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, Florida, USA
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27
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Iannitto E, Bellei M, Amorim S, Ferreri AJM, Marcheselli L, Cesaretti M, Haioun C, Mancuso S, Bouabdallah K, Gressin R, Tripodo C, Traverse‐Glehen A, Baseggio L, Zupo S, Stelitano C, Castagnari B, Patti C, Alvarez I, Liberati AM, Merli M, Gini G, Cabras MG, Dupuis J, Tessoulin B, Perrot A, Re F, Palombi F, Gulino A, Zucca E, Federico M, Thieblemont C. Efficacy of bendamustine and rituximab in splenic marginal zone lymphoma: results from the phase II BRISMA/IELSG36 study. Br J Haematol 2018; 183:755-765. [DOI: 10.1111/bjh.15641] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/11/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Emilio Iannitto
- Department of Oncology ‐ Haematology Unit AOU Policlinico P. Giaccone Palermo Italy
| | - Monica Bellei
- Fondazione Italiana Linfomi (FIL) c/o Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia Modena Italy
| | - Sandy Amorim
- APHP, Saint‐Louis Hospital Haemato‐Oncology Paris France
| | | | - Luigi Marcheselli
- Fondazione Italiana Linfomi (FIL) c/o Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia Modena Italy
| | - Marina Cesaretti
- Fondazione Italiana Linfomi (FIL) c/o Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia Modena Italy
| | - Corinne Haioun
- Lymphoid Malignancies Unit University Hospital Henri Mondor Creteil France
| | - Salvatrice Mancuso
- Department of Oncology ‐ Haematology Unit AOU Policlinico P. Giaccone Palermo Italy
| | | | - Remy Gressin
- Onco‐Haematology Department University Hospital Grenoble Grenoble France
- INSERM, U823 Génétique et Epigenetique des cancers lymphoïdes Institut Albert Bonniot Grenoble France
| | - Claudio Tripodo
- Tumour Immunology Unit Human Pathology Section Department of Health Science University of Palermo Palermo Italy
| | | | - Lucile Baseggio
- Centre Hospitalier Lyon Sud Laboratoire d'Hématologie cellulaire Université Lyon 1 Pierre Benite France
| | - Simonetta Zupo
- Molecular Diagnostic Unit Policlinico San Martino Genova Italy
| | - Caterina Stelitano
- Division of Haematology Azienda Ospedaliera Bianchi‐Melacrino‐Morelli Reggio Calabria Italy
| | | | - Caterina Patti
- Division of Haematology Azienda Ospedali Riuniti Villa Sofia‐Cervello Palermo Italy
| | - Isabel Alvarez
- Arcispedale Santa Maria Nuova UOC of Haematology AUSL Reggio Emilia/IRCCS Reggio Emilia Italy
| | - Anna Marina Liberati
- Santa Maria Hospital Oncology‐Haematology Perugia University of Perugia Perugia Italy
| | - Michele Merli
- University Hospital Ospedale di Circolo e Fondazione Macchi ASST Settelaghi Varese Italy
| | - Guido Gini
- Division of Haematology Ospedali Riuniti Ancona Italy
| | | | - Jean Dupuis
- Lymphoid Malignancies Unit Henri Mondor Hospital Creteil France
| | - Benoit Tessoulin
- Department of Clinical Haematology Nantes University Hospital Nantes France
| | - Aurore Perrot
- Haematology Department University Hospital Vandoeuvre Les Nancy France
| | - Francesca Re
- Azienda Ospedaliero‐Universitaria di Parma UO Ematologia e CTMO Parma Italy
| | - Francesca Palombi
- Haematology and Stem Cell Transplant Regina Elena National Cancer Institute Rome Italy
| | - Alessandro Gulino
- Tumour Immunology Unit Human Pathology Section Department of Health Science University of Palermo Palermo Italy
| | - Emanuele Zucca
- IOSI, Oncology Institute of Southern Switzerland and IOR Institute of Oncology Research Università della Svizzera Italiana (USI) Bellinzona Switzerland
| | - Massimo Federico
- Department of Diagnostic, Clinical, and Public Health Medicine University of Modena and Reggio Emilia Modena Italy
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Rituximab monotherapy in splenic marginal zone lymphoma: prolonged responses and potential benefit from maintenance. Blood 2018; 132:666-670. [PMID: 29914978 DOI: 10.1182/blood-2018-02-833608] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/02/2018] [Indexed: 01/11/2023] Open
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Abstract
PURPOSE OF REVIEW The purpose of the study is to summarize the current conundrums in the management of marginal zone lymphomas (MZL). RECENT FINDINGS In 2017, the US Food and Drug Administration (FDA) approved ibrutinib, a first in class Bruton Tyrosine Kinase inhibitor, for the treatment of relapsed/refractory MZL based on pivotal open-label phase II trial demonstrating an overall response rates of 48%. Clinical trials design utilizing chemotherapy-free regimens for relapsed/refractory disease are gaining popularity. Recent studies have identified multiple genetic biomarkers that helped characterize and prognosticate different subtypes of MZL. MZLs are heterogeneous, mostly indolent, malignancies derived from B lymphocytes. Three disease subtypes are recognized, extranodal, nodal, and splenic. The disease characteristics, clinical picture, and treatment algorithms vary considerably based on subtype and site of involvement. Recent discoveries have enhanced our knowledge of the pathogenesis of MZLs leading to development of more accurate prognostic models as well as novel targeted systemic therapies.
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Kalpadakis C, Pangalis GA, Angelopoulou MK, Sachanas S, Vassilakopoulos TP. Should rituximab replace splenectomy in the management of splenic marginal zone lymphoma? Best Pract Res Clin Haematol 2018; 31:65-72. [DOI: 10.1016/j.beha.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 02/07/2023]
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Ramos CA. Marginal Zone Lymphomas (Extranodal/Malt, Splenic, and Nodal). Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ortega JL, Cabanillas F, Rivera N, Tirado-Gomez M, Hallman D, Pardo WI, Bruno M. Results of Upfront Therapy for Marginal Zone Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:879-883. [PMID: 29042174 DOI: 10.1016/j.clml.2017.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 08/15/2017] [Accepted: 09/15/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Marginal zone lymphomas (MZLs) are indolent disorders composed of 3 subtypes: extranodal marginal zone lymphoma (MALT), splenic marginal zone lymphoma (SMZL), and nodal marginal zone lymphoma (NMZL). Early-stage MALT is treated with radiotherapy or antibiotics, and advanced MALT and NMZL are managed with either watch and wait or chemotherapy. SMZLs are treated with splenectomy or rituximab. However, because these approaches have failed to cure patients with SMZL and NMZL, we have systematically used upfront chemotherapy for them, as well as for advanced MALT. We report the outcomes of this approach. PATIENTS AND METHODS A total of 44 patients with MZL were identified from our database and divided into 2 groups. Group 1 (22 with early-stage MALT) patients received either radiotherapy (n = 17) or antibiotics with or without surgery (n = 5). Group 2 included 9 patients with advanced MALT, 9 with SMZL, and 4 with NMZL. Group 2 was treated with FND-R (fludarabine 25 mg/m2 on days 1 to 3, mitoxantrone 10 mg/m2 on day 1, dexamethasone 20 mg on days 1 to 5, and rituximab 375 mg/m2 on day 1; n = 14) or CHOP-R (cyclophosphamide 750 mg/m2 on day 1, doxorubicin 50 mg/m2 on day 1, vincristine 2 mg intravenous push on day 1, prednisone 100 mg/m2 orally on days 1 to 5, rituximab 375 mg/m2 on day 1; n = 8), followed by maintenance rituximab for 70%. RESULTS All patients achieved complete remission, and only 2 patients in group 1 had developed a relapse at 70 and 75 months. Both relapses were stage I MALT that had initially been treated with radiotherapy. Both were salvaged with FND-R and remained free of disease at 27 and 39 months after the relapse. At 10 years, the failure-free survival for the 44 patients was 80% and the overall survival was 100%. None of the patients in group 2 developed a relapse. The long-term toxicities have been acceptable. CONCLUSIONS The excellent responses using upfront chemotherapy for MZL suggests that this disorder is curable. Our results should be confirmed in a prospective trial.
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Affiliation(s)
- José L Ortega
- University District Hospital, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Fernando Cabanillas
- University District Hospital, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; Hospital Auxilio Mutuo Cancer Center, San Juan, Puerto Rico.
| | - Noridza Rivera
- University District Hospital, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; Hospital Auxilio Mutuo Cancer Center, San Juan, Puerto Rico
| | - Maribel Tirado-Gomez
- University District Hospital, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Deana Hallman
- University District Hospital, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Kennedy ND, Lê GN, Kelly ME, Harding T, Fadalla K, Winter DC. Surgical management of splenic marginal zone lymphoma. Ir J Med Sci 2017; 187:343-347. [PMID: 29043543 DOI: 10.1007/s11845-017-1689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Splenic marginal zone lymphoma (SMZL) is a rare indolent B-cell lymphoma with variable prognosis. As a result, there is sparse knowledge on the role of splenectomy and best management approaches. We aim to explore management strategies and outcomes amongst the cohort of SMZL patients at our centre. METHOD A retrospective review of all splenectomies performed at a tertiary referral unit over a 23-year period was assessed. Immunohistochemical and pathological results of splenic samples, bone marrow biopsies, and peripheral blood were compiled. Operative management, surgical, and survival outcomes were assessed. Prognostic stratifications were applied and survival rates were calculated. RESULTS Eight cases of SMZL from a database of 693 splenectomies were identified. All patients had intermediate/high-risk disease. All patients underwent splenectomy with one patient receiving preoperative rituximab. All patients had progression-free survival and resolution of disease. CONCLUSION Based on the data obtained, current practice requires defined guidelines and centralised care.
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Affiliation(s)
- N D Kennedy
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - G N Lê
- The National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - M E Kelly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - T Harding
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - K Fadalla
- Department of Haematology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D C Winter
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Pata G, Bartoli M, Damiani E, Solari S, Anastasia A, Pagani C, Tucci A. Still a role for surgery as first-line therapy of splenic marginal zone lymphoma? Results of a prospective observational study. Int J Surg 2017; 41:143-149. [DOI: 10.1016/j.ijsu.2017.03.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/13/2017] [Accepted: 03/28/2017] [Indexed: 02/07/2023]
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Starr AG, Caimi PF, Fu P, Massoud MR, Meyerson H, Hsi ED, Mansur DB, Cherian S, Cooper BW, De Lima MJ, Lazarus HM, Gerson SL, Jagadeesh D, Smith MR, Dean RM, Pohlman BL, Hill BT, William BM. Splenic marginal zone lymphoma: excellent outcomes in 64 patients treated in the rituximab era. Hematology 2017; 22:405-411. [DOI: 10.1080/10245332.2017.1279842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Adam G. Starr
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Paolo F. Caimi
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - PingFu Fu
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Mira R. Massoud
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Howard Meyerson
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Eric D. Hsi
- Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - David B. Mansur
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Sheen Cherian
- Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Brenda W. Cooper
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Marcos J.G. De Lima
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Hillard M. Lazarus
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Stanton L. Gerson
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Deepa Jagadeesh
- Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Mitchell R. Smith
- Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Robert M. Dean
- Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Brad L. Pohlman
- Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Brian T. Hill
- Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Basem M. William
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
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Splenic marginal zone lymphoma: a literature review of diagnostic and therapeutic challenges. Rev Bras Hematol Hemoter 2016; 39:146-154. [PMID: 28577652 PMCID: PMC5457460 DOI: 10.1016/j.bjhh.2016.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/26/2016] [Accepted: 09/09/2016] [Indexed: 12/11/2022] Open
Abstract
Splenic marginal zone lymphoma (SMZL) is a low-grade B-cell non-Hodgkin's lymphoma characterized by massive splenomegaly, moderate lymphocytosis with or without villous lymphocytes, rare involvement of peripheral lymph nodes and indolent clinical course. As a rare disease, with no randomized prospective trials, there is no standard of care for SMZL so far. Splenectomy has been done for many years as an attempt to control disease, but nowadays it has not been encouraged as first line because of new advances in therapy as rituximab, that are as effective with minimal toxicity. Facing these controversies, this review highlights advances in the literature regarding diagnosis, prognostic factors, treatment indications and therapeutic options.
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Kalpadakis C, Pangalis GA, Angelopoulou MK, Vassilakopoulos TP. Treatment of splenic marginal zone lymphoma. Best Pract Res Clin Haematol 2016; 30:139-148. [PMID: 28288709 DOI: 10.1016/j.beha.2016.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/06/2023]
Abstract
Splenic marginal zone lymphoma (SMZL) is a distinct lymphoma entity characterized by an indolent clinical course and prolonged survival. Treatment is not standardized, since there are no prospective randomized trials in large series of SMZL patients. Splenectomy and rituximab represent the most effective treatment strategies used so far. The addition of chemotherapy to rituximab has not further improved the outcome, although this issue requires further investigation. Rituximab monotherapy has been associated with high response rates (∼90%), with approximately half of these responses being complete, even at the molecular level. More importantly, many of these responses are long-lasting, with a reported 7-year progression-free survival (PFS) at the rate of 69%. Maintenance rituximab treatment has been associated with further improvement of the quality of response as well as longer response duration in studies derived from one group of investigators. Based on its high efficacy and the good safety profile, rituximab represent one of the best treatment options for SMZL patients. Moreover, rituximab retains its efficacy in the relapse setting in most cases. Splenectomy is a meaningful alternative to rituximab in patients with bulky splenomegaly and cytopenias, without extensive bone marrow infiltration, who are fit for surgery. However splenectomy cannot completely eradicate the disease and it is also associated with greater morbidity or even mortality compared to rituximab. The choice of one of these two treatment approaches (rituximab or splenectomy) should mainly be based on patient's characteristics and on the disease burden. Novel agents are currently testing in low grade lymphomas including a small number of SMZL patients with promising results.
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Affiliation(s)
- Christina Kalpadakis
- Department of Haematology, Heraklion University Hospital, 71001, University of Crete, Heraklion, Crete, Greece.
| | - Gerassimos A Pangalis
- Department of Haematology, Athens Medical Center-Psychikon Branch, 11525, Athens, Greece.
| | - Maria K Angelopoulou
- Department of Haematology, National and Kapodistrian University, Laikon General Hospital, Athens, Greece.
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Kalpadakis C, Pangalis GA, Angelopoulou MK, Sachanas S, Vassilakopoulos TP. Current and emerging treatment approaches for splenic marginal zone lymphoma. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1198255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Christina Kalpadakis
- Department of Haematology, Heraklion University Hospital, University of Crete, Heraklion, Crete, Greece
| | | | - Maria K. Angelopoulou
- Department of Haematology, National and Kapodistrian University, Laikon General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Haematology, Athens Medical Center- Psychikon Branch, Athens, Greece
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Paraneoplastic Syndrome in Splenic Marginal Zone Lymphoma: A Rare Phenomenon of Paraplegia as an Atypical Presenting Manifestation. Case Rep Hematol 2016; 2016:7034167. [PMID: 27293921 PMCID: PMC4879228 DOI: 10.1155/2016/7034167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/15/2016] [Accepted: 03/28/2016] [Indexed: 01/02/2023] Open
Abstract
We describe a case presenting complaint of complete lower body paraparesis, which was discovered to have splenic marginal zone lymphoma (SMZL). While paraneoplastic syndromes are more common in tumors, such as small cell lung cancer, very few reports exist on this condition with SMZL. We describe such a rare entity with a clinical course spanning twenty-four months after diagnosis.
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Splenic marginal zone lymphoma: from genetics to management. Blood 2016; 127:2072-81. [DOI: 10.1182/blood-2015-11-624312] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 03/07/2016] [Indexed: 12/16/2022] Open
Abstract
AbstractSplenic marginal zone lymphoma (SMZL) is a rare B-cell malignancy involving the spleen, bone marrow, and frequently the blood. SMZL lymphomagenesis involves antigen and/or superantigen stimulation and molecular deregulation of genes (NOTCH2 and KLF2) involved in the physiological differentiation of spleen marginal zone B cells. Diagnosis requires either spleen histology or, alternatively, the documentation of a typical cell morphology and immunophenotype on blood cells coupled with the detection of intrasinusoidal infiltration by CD20+ cells in the bone marrow. Among B-cell tumors, deletion of 7q and NOTCH2 mutations are almost specific lesions of SMZL, thus representing promising diagnostic biomarkers of this lymphoma. Although the majority of SMZLs show an indolent course with a median survival of approximately 10 years, nearly 30% of patients experience a poor outcome. No randomized trials are reported for SMZL, and few prospective trials are available. A watch-and-wait approach is advisable for asymptomatic patients. Treatment options for symptomatic patients ranges from splenectomy to rituximab alone or combined with chemotherapy. In some geographic areas, a subset of patients with SMZL associates with hepatitis C virus infection, prompting virus eradication as an effective lymphoma treatment. It would be worthwhile to explore deregulated cellular programs of SMZL as therapeutic targets in the future; improved clinical and biological prognostication will be essential for identifying patients who may benefit from novel approaches.
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Kalpadakis C, Pangalis GA, Sachanas S, Rontogianni D, Korkolopoulou P, Milionis V, Vassilakopoulos TP, Papadaki HA, Angelopoulou MK. No evidence of splenic disease in patients with splenic marginal zone lymphoma undergoing splenectomy for autoimmune hemolytic anemia after monotherapy with rituximab. Leuk Lymphoma 2016; 57:2705-8. [DOI: 10.3109/10428194.2016.1157877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Srikumar T, Markow M, Centeno B, Hoffe S, Tao J, Fernandez H, Strosberg J, Shibata D. Synchronous rectal adenocarcinoma and splenic marginal zone lymphoma. ACTA ACUST UNITED AC 2016; 23:e70-4. [PMID: 26966416 DOI: 10.3747/co.23.2711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Synchronous cancers of different primary origin are rare. Here, we describe the case of a patient with concomitant diagnoses of rectal adenocarcinoma and splenic marginal zone lymphoma (smzl). A 57-year-old woman initially presented with abdominal pain. Physical examination and computed tomography demonstrated massive splenomegaly, and a complete blood count revealed microcytic anemia and lymphopenia. During the subsequent evaluation, she presented with hematochezia, melena, and constipation, which prompted gastroenterology referral. Subsequent endoscopic rectal ultrasonography revealed a T3N1 moderately differentiated rectal adenocarcinoma, with computed tomography imaging of chest, abdomen, and pelvis confirming no metastasis. Thus, the cancer was classified as clinical stage T3N1M0, stage iii. Bone marrow biopsy confirmed co-existing marginal zone lymphoma, and with the clinical presentation of massive splenomegaly, a diagnosis of smzl was made. The patient's management was individually tailored for simultaneous optimal treatment of both conditions. Concurrent treatment with neoadjuvant rituximab and 5-fluorouracil chemotherapy, with external-beam radiation therapy to the pelvis, was administered, followed by surgery consisting of en bloc splenectomy and distal pancreatectomy, and low anterior resection. The patient completed a standard course of adjuvant folfox (fluorouracil-leucovorin-oxaliplatin) chemotherapy and has remained disease-free for 7 years. To our knowledge, this report is the first to specifically describe simultaneous diagnoses of locally advanced rectal cancer and smzl. We also describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation.
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Affiliation(s)
- T Srikumar
- Morsani College of Medicine, University of South Florida, Tampa, FL, U.S.A.;; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - M Markow
- Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, FL, U.S.A.;; Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - B Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - S Hoffe
- Department of Radiation Oncology and Therapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - J Tao
- Department of Hematopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - H Fernandez
- Department of Blood and Marrow Transplant, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - J Strosberg
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - D Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, U.S.A
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van Stee LL, Boston SE, Singh A, Romanelli G, Rubio-Guzman A, Scase TJ. Outcome and Prognostic Factors for Canine Splenic Lymphoma Treated by Splenectomy (1995-2011). Vet Surg 2015; 44:976-82. [PMID: 26426095 DOI: 10.1111/vsu.12405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the outcome of canine splenic lymphoma treated with splenectomy and to evaluate prognostic factors, including involvement of other sites, adjuvant chemotherapy, and the effect of World Health Organization (WHO) histological classification of canine malignant lymphoma. DESIGN Multi-institutional, retrospective study. ANIMALS Client-owned dogs (n = 28). METHODS Medical records (1995-2011) of dogs with a histological diagnosis of splenic lymphoma and treated by splenectomy submitted by Veterinary Society of Surgical Oncology members were reviewed. Included were dogs treated with or without adjuvant therapy. Overall survival, disease-free interval, and cause of death were determined. Prognostic factors and the WHO histological classification of canine malignant lymphoma were evaluated with respect to outcome. RESULTS Dogs with splenic lymphoma treated by splenectomy had a 1-year survival rate of 58.8%, after which no animals died of their disease. B cell lymphoma held a better prognosis for survival than other variants of splenic lymphoma. Marginal zone lymphoma and mantle cell lymphoma were the most common B cell lymphoma subtypes in our study. Hemoabdomen and clinical signs related to splenic lymphoma, including abdominal distention, lethargy, and anorexia, were poor prognostic indicators, whereas disease confined to the spleen was a positive prognostic indicator. Pre- or postoperative adjuvant chemotherapy did not provide a survival benefit. CONCLUSION Based on our sample population, splenectomy alone was an effective treatment for splenic lymphoma in cases with disease confined to the spleen. Chemotherapy may not improve survival in cases of lymphoma restricted to the spleen.
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Affiliation(s)
- Lucinda L van Stee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sarah E Boston
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Ameet Singh
- Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | | | | | - Tim J Scase
- Bridge Pathology Ltd., Bristol, United Kingdom
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Iannitto E, Luminari S, Tripodo C, Mancuso S, Cesaretti M, Marcheselli L, Merli F, Stelitano C, Carella AM, Fragasso A, Montechiarello E, Ricciuti G, Pulsoni A, Paulli M, Franco V, Federico M. Rituximab with cyclophosphamide, vincristine, non-pegylated liposomal doxorubicin and prednisone as first-line treatment for splenic marginal zone lymphoma: a Fondazione Italiana Linfomi phase II study. Leuk Lymphoma 2015; 56:3281-7. [DOI: 10.3109/10428194.2015.1029925] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Xing KH, Kahlon A, Skinnider BF, Connors JM, Gascoyne RD, Sehn LH, Savage KJ, Slack GW, Shenkier TN, Klasa R, Gerrie AS, Villa D. Outcomes in splenic marginal zone lymphoma: analysis of 107 patients treated in British Columbia. Br J Haematol 2015; 169:520-7. [PMID: 25854936 DOI: 10.1111/bjh.13320] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/01/2015] [Indexed: 11/28/2022]
Abstract
Splenic marginal zone lymphoma (SMZL) accounts for less than 2% of all non-Hodgkin lymphomas. We identified 107 cases diagnosed with SMZL between 1985 and 2012 from the British Columbia Cancer Agency Centre for Lymphoid Cancer and Lymphoma Pathology Databases. Patient characteristics were: median age 67 years (range 30-88), male 40%, stage IV 98%, splenomegaly 93%, bone marrow involvement 96%, peripheral blood involvement 87%. As initial treatment, 52 underwent splenectomy (10 with chemotherapy), 38 chemotherapy alone (21 chemoimmunotherapy containing rituximab, 1 rituximab alone), two antivirals for hepatitis C, and 15 were only observed. The 10-year overall survival for first-line splenectomy versus chemotherapy was 61% and 42%, respectively [Hazard Ratio (HR) 0·48, 95% confidence interval (CI) 0·26-0·88, P = 0·017]. The 10-year failure-free survival (FFS) after first-line splenectomy vs chemotherapy was 39% and 14%, respectively (HR 0·48, 95% CI 0·28-0·80, P = 0·004). Among the 38 patients who received first-line chemotherapy, FFS was similar between those receiving rituximab (n = 22) and those who did not (n = 16) (HR 0·64, 95% CI 0·31-1·34, P = 0·238). Fifteen patients transformed to aggressive lymphoma with median time to transformation of 3·5 years (range 6 months to 12 years) and the 10-year transformation rate was 18%. In conclusion, splenectomy remains a reasonable treatment for patients with SMZL.
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Affiliation(s)
- Katharine H Xing
- Department of Medical Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, BC, Canada
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Tarella C, Arcaini L, Baldini L, Barosi G, Billio A, Marchetti M, Rambaldi A, Vitolo U, Zinzani PL, Tura S. Italian Society of Hematology, Italian Society of Experimental Hematology, and Italian Group for Bone Marrow Transplantation Guidelines for the Management of Indolent, Nonfollicular B-Cell Lymphoma (Marginal Zone, Lymphoplasmacytic, and Small Lymphocytic Lymphoma). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:75-85. [DOI: 10.1016/j.clml.2014.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 12/19/2022]
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Lenglet J, Traullé C, Mounier N, Benet C, Munoz-Bongrand N, Amorin S, Noguera ME, Traverse-Glehen A, Ffrench M, Baseggio L, Felman P, Callet-Bauchu E, Brice P, Berger F, Salles G, Brière J, Coiffier B, Thieblemont C. Long-term follow-up analysis of 100 patients with splenic marginal zone lymphoma treated with splenectomy as first-line treatment. Leuk Lymphoma 2014; 55:1854-60. [DOI: 10.3109/10428194.2013.861067] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Matutes E. Clinical and biological diversity of splenic marginal zone lymphoma. Expert Rev Anticancer Ther 2014; 9:1185-9. [DOI: 10.1586/era.09.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Yasuyama M, Kawauchi K, Otsuka K, Tamura H, Fujibayashi M. [Successful treatment with rituximab in a patient with splenic marginal zone B-cell lymphoma accompanied by cold agglutinin disease]. Nihon Ronen Igakkai Zasshi 2014; 51:569-75. [PMID: 25749330 DOI: 10.3143/geriatrics.51.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 81-year-old man was admitted to our hospital due to dyspnea in July 2008. A physical examination revealed marked splenomegaly, and the results of laboratory tests were as follows: hemoglobin (Hb)=7.0 g/dL, Ret=6.4%, WBC=24,100/μL (Ly: 20,003/μL), indirect bilirubin=3.6 mg/dL, LDH=232 IU/L. The cold agglutinin titer was 1 : 8,192, and a direct antiglobulin test was positive. A PET scan showed abnormal accumulation in the spleen and bone marrow. A bone marrow aspirate examination and biopsy demonstrated diffuse involvement of abnormal lymphocytes that were found to be positive for CD20 and negative for CD5, CD10, and cyclin D1. The immunoglobulin genes were clonally rearranged. Based on these findings, splenic marginal zone B-cell lymphoma (SMZL) associated with cold agglutinin disease (CAD) was diagnosed. Because the patient refused splenectomy, he was treated with four cycles of rituximab therapy (375 mg/kg, once a week). The Hb level and lymphocyte count subsequently normalized and the splenomegaly resolved. One year later, he relapsed and was again treated with rituximab therapy with complete remission. CAD accompanied by SMZL is very rare. Rituximab may be chosen as an alternative and effective therapeutic option in patients with SMZL-particularly those with autoimmune hemolytic anemia.
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Affiliation(s)
- Masako Yasuyama
- Department of Medicine, Tokyo Women's Medical University, Medical Center East; Toshima Central Hospital
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