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Ning Y, He H, Li Q, Zhao D, Xie D. The prognosis of patients with primary pulmonary mucosa-associated lymphoid tissue lymphoma: Treated with surgery or chemotherapy? Eur J Cardiothorac Surg 2024; 65:ezae064. [PMID: 38400749 DOI: 10.1093/ejcts/ezae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES The goal of this project was to evaluate the effect of surgical treatment and the long-term survival of patients with staged IE/IIE pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS From January 2004 to December 2018, we retrospectively analysed 96 patients diagnosed with low-stage primary pulmonary MALT lymphoma according to the modified Ann Arbor staging system (IE/IIE). We compared the outcomes of different treatment modalities for staged IE/IIE MALT lymphoma. Progression-free survival (PFS) and overall survival were estimated using Kaplan-Meier curves, and the differences were compared using the log-rank test. The Cox proportional hazards model was used in this study. RESULTS The median PFS time of low-staged MALT lymphomas was 118 months. The overall survival and PFS of the radical surgery group and the biopsy + chemotherapy group suggested no significant difference (P = 0.63, P = 0.65). Patients positive for Blc-2 and Ki-67 suffered from a compromised PFS (P = 0.023, P = 0.006). The Cox adjusted proportional hazards model analysis suggested that surgical procedures were not protective factors for patients with low-staged (IE/IIE) pulmonary MALT lymphoma, whereas being positive for Blc-2 and Ki-67 was a risk factor for patients with low-staged pulmonary MALT lymphoma (hazard ratio: 9.567; P = 0.044; hazard ratio: 6.042, P = 0.049). CONCLUSIONS Our findings suggested that for staged IE/IIE pulmonary MALT lymphoma, radical surgical resection did not provide a survival benefit compared with chemotherapy after biopsy. Thus, radical surgery may be avoided unless biopsy is necessary for a diagnosis that requires sublobar resection. For those lesions that were Blc-2- or Ki-67-positive, compromised survival may be suggested.
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Affiliation(s)
- Ye Ning
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Haiyan He
- Department of Hematology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
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2
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Ando T, Kato H, Matsuo M. Different CT imaging findings between histological subtypes in patients with primary thyroid lymphoma. Radiol Med 2022; 127:191-198. [PMID: 35031960 DOI: 10.1007/s11547-022-01447-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 12/31/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE This study evaluates the differences in CT imaging findings between diffuse large B cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid gland. METHODS This study included 18 patients with histopathologically confirmed primary thyroid lymphoma (nine with DLBCL and nine with MALT lymphoma). All patients underwent pretreatment CT imaging. We retrospectively reviewed all images and compared the imaging findings between the two pathologies. RESULTS The maximum diameter was significantly greater in DLBCL than in MALT lymphoma (67.7 ± 17.0 mm vs. 41.0 ± 27.2 mm, p < 0.01). Diffuse type (78% vs. 11%, p < 0.01), thickening of the isthmus (78% vs. 22%, p < 0.05), invasion of surrounding tissues (78% vs. 0%, p < 0.01), and regional lymphadenopathy (44% vs. 0%, p < 0.05) were more frequent in DLBCL than in MALT lymphoma. However, preserved peripheral thyroid tissue was more frequent in MALT lymphoma than in DLBCL (78% vs. 22%, p < 0.05). CONCLUSIONS The maximum diameter, morphological patterns (diffuse or nodular type), thickening of the isthmus, invasion of surrounding tissues, regional lymphadenopathy, and preserved peripheral thyroid tissue were useful CT imaging features in differentiating DLBCL from MALT lymphoma of the thyroid gland.
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Affiliation(s)
- Tomohiro Ando
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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3
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Active surveillance of primary extranodal marginal zone lymphoma of bronchus-associated lymphoid tissue. Blood Adv 2021; 5:345-351. [PMID: 33496731 DOI: 10.1182/bloodadvances.2020003213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022] Open
Abstract
Although patients with bronchus-associated lymphoid tissue (BALT) lymphoma show an indolent clinical course, appropriate disease management at diagnosis is not well defined. This study aimed to compare 3 treatment strategies for patients with BALT lymphoma: active surveillance, systemic chemotherapy or immunotherapy at diagnosis, or complete surgical resection at diagnosis. We conducted a retrospective study of all patients with new diagnoses of marginal zone lymphoma (MZL) involving the lung who were treated at the Memorial Sloan Kettering Cancer Center between 1995 and 2017. Primary BALT lymphoma was defined as disease confined to the lungs and adjacent lymph nodes. Active surveillance was defined as a documented observation plan and ≥3 months of follow-up before initiating treatment. Overall survival (OS) and event-free survival (EFS) were compared between treatment groups. We reviewed 200 consecutive patients with MZL involving the lung; 123 met the inclusion criteria and were managed by active surveillance (47%), complete surgical resection (41%), or systemic chemotherapy or immunotherapy (11%). With a median follow-up of >60 months, surgical resection was associated with a superior EFS compared with active surveillance and systemic treatment (6-year EFS: 74% vs 65% vs 62%, respectively; P = .013). Larger lesions and thrombocytopenia were associated with shorter EFS. All groups had excellent OS at 6 years (93%), albeit with a slight superiority for surgical resection (100%) over active surveillance (91%) and systemic treatment (76%) (P = .024). BALT lymphoma is an indolent disease that can often be managed expectantly and not require therapy for many years.
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4
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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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5
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Braddy A, Mogal RJ, Maddox AJ, Barlow ABT. Pulmonary MALToma Synchronous with Metastatic Prostate Adenocarcinoma: A Diagnostic Challenge. Eur J Case Rep Intern Med 2020; 7:001711. [PMID: 32789141 PMCID: PMC7417046 DOI: 10.12890/2020_001711] [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: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We describe the novel case of a patient presenting with pulmonary mucosa-associated lymphoid tissue lymphoma (pMALToma) synchronous with metastatic prostate adenocarcinoma. MATERIALS AND METHODS We report the clinical, laboratory, radiological and histological findings of the above patient. RESULTS While the patient's metastatic prostate adenocarcinoma responded well to chemo-radio-hormonal therapy, a persistent area of lung consolidation was noted and further investigated, leading to the diagnosis of concurrent pMALToma. CONCLUSION It is important to pursue further investigation when there appears to be persistent change or altered disease response in malignancy if there is evidence for disease response elsewhere, as there may be two synchronous primary cancers. LEARNING POINTS This is a novel case where pulmonary mucosa-associated lymphoid tissue lymphoma (pMALToma), a rare disease entity, presented synchronously and asymptomatically in a patient with metastatic prostate adenocarcinoma.From an instructive errors perspective, it is important to consider synchronous primary malignancy and pursue further investigations, as appropriate, when there appears to be persistent change or altered disease response if there is evidence for disease response elsewhere.
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Affiliation(s)
- Aaron Braddy
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Rahul Janardan Mogal
- Department of Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Anthony John Maddox
- Department of Histopathology, West Hertfordshire Hospitals NHS Trust, Watford, UK
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Wang L, Ye G, Liu Z, Shi L, Zhan C, Gu J, Luo R, Lin Z, Ge D, Wang Q. Clinical characteristics, diagnosis, treatment, and prognostic factors of pulmonary mucosa-associated lymphoid tissue-derived lymphoma. Cancer Med 2019; 8:7660-7668. [PMID: 31691549 PMCID: PMC6912039 DOI: 10.1002/cam4.2683] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/21/2019] [Accepted: 10/21/2019] [Indexed: 01/22/2023] Open
Abstract
Primary pulmonary mucosa‐associated lymphoid tissue‐derived (MALT) lymphoma is a rare disease with a favorable prognosis. However, its clinical characteristics, diagnosis, treatment, and prognoses remain unclear. We retrospectively analyzed 80 patients with pathologically confirmed MALT lymphoma from 2006 to 2018. The clinical characteristics, diagnosis, treatments, and prognoses of all the 80 patients were recorded. Patients were stratified into surgery and biopsy groups, respectively, to evaluate the role of surgery in the diagnosis and treatment of MALT lymphoma. The prognoses were compared between different clinical characteristics and treatments. Pathological diagnoses were confirmed by surgery, bronchoscopy, and percutaneous biopsy. Thirty patients were treated by surgery. While MALT lymphoma was only diagnosed by bronchofiberoscopy or bercutaneous biopsy in four of 18 patients in the surgery group who underwent the procedure. Six patients received adjuvant chemotherapy and one patient received involved‐field radiotherapy in surgery group. Thirty‐one patients were treated with chemotherapy alone, one patient was treated with radiotherapy, one patient received only symptomatic and supportive treatment, and waiting and watching without treatment were recommended in 17 patients in biopsy group. Eight patients died during follow‐up and the 5‐year survival rate was 87.1%. Tumor number, treatment, and age were prognostic factors for overall survival (OS), but age was the only independent prognostic factor according to multivariate analysis. While, tumor number was the only prognostic factor in the analysis about progression‐free survival (PFS). No significant difference was found in OS or PFS between patients treated with and without surgical resection. MALT lymphoma is an indolent disease with favorable treatment outcome. Tumor number is associated with PFS and age is the only significant prognostic factor for pulmonary MALT lymphoma patients because of its indolent nature, but surgery still plays an important role in the diagnosis and treatment of MALT lymphoma.
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Affiliation(s)
- Lin Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guanzhi Ye
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhonghe Liu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Shi
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Gu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Albano D, Durmo R, Treglia G, Giubbini R, Bertagna F. 18F-FDG PET/CT or PET Role in MALT Lymphoma: An Open Issue not Yet Solved-A Critical Review. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:137-146. [PMID: 32029397 DOI: 10.1016/j.clml.2019.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma involves the mucosa-associated lymphoid tissue potentially arising from any mucosal site, with the stomach as the most common site of involvement. MALT lymphoma is not usually an aggressive disease with a good prognosis except for selected cases. Fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is a noninvasive imaging tool used for staging, restaging, and evaluation of the treatment response in non-Hodgkin and Hodgkin lymphoma. However, its effective role in MALT lymphoma is not yet clear. The open question is whether these lymphomas are 18F-FDG avid or not, with conflicting results reported in the literature. Consequently, the possible clinical role of 18F-FDG PET/CT for staging and restaging purposes is under debate. The aim of the present review was to analyze the reported data about the role of 18F-FDG PET or PET/CT in patients with MALT lymphoma. We performed a comprehensive computer literature search of the Scopus, Cochrane, PubMed/MEDLINE, and Embase databases, including articles reported up to August 2019. We included 32 studies that had analyzed 18F-FDG PET or PET/CT for patients with MALT lymphoma. We analyzed the metabolic behavior of MALT lymphoma using 18F-FDG PET and the effect of the PET findings in the staging, treatment response evaluation, and prognosis.
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Affiliation(s)
- Domenico Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy.
| | - Rexhep Durmo
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland; Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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8
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Abstract
A 57-year-old man had a diagnosis of a bronchial mucosa-associated lymphoid tissue lymphoma in the left lung and monoclonal gammopathy. The patient underwent whole-body C-methionine PET/CT, in order to evaluate the amino acid avidity of the lesion and to stage the bronchial mucosa-associated lymphoid tissue lymphoma. C-methionine uptake was detected in the lung lesion and in the mediastinal lymph nodes.
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9
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Cencini E, Fabbri A, Lauria F, Bocchia M. Long-term efficacy and toxicity of rituximab plus fludarabine and mitoxantrone (R-FM) for gastric marginal zone lymphoma: a single-center experience and literature review. Ann Hematol 2018; 97:821-829. [PMID: 29340761 DOI: 10.1007/s00277-018-3243-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/06/2018] [Indexed: 11/28/2022]
Abstract
There is no consensus about the best treatment option for patients with HP-negative gastric MALT lymphomas or persistent disease after HP eradication.We have investigated fludarabine and mitoxantrone with rituximab (R-FM) as first-line treatment. A cohort of 13 patients was analyzed. Induction treatment consisted of fludarabine (25 mg/m2 i.v. on days 2 to 4), mitoxantrone (10 mg/m2 i.v. on day 2), and rituximab (375 mg/m2 i.v. on day 1), for up to six cycles every 28 days. All patients achieved a complete remission, a median of four cycles was given. Treatment-related toxicities were mainly hematologic, with grade 3-4 neutropenia observed in 11/13 patients (84.6%). One patient had grade 3 febrile neutropenia, two patients developed prolonged pancytopenia (15%), and one patient experienced CMV reactivation at 2 months. After a median follow-up of 84 months, 1/13 had disease relapse and received total gastrectomy; estimated 10-year progression-free survival and overall survival were 92.4 and 100%, respectively. Our study suggests R-FM regimen has a high long-term efficacy for untreated HP-negative gastric MALT lymphoma patients and HP-positive patients who failed HP eradication. The elevated incidence of grade 3-4 hematological toxicity, yet manageable, makes this treatment less safe compared to rituximab in combination with chlorambucil or bendamustine.
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Affiliation(s)
- Emanuele Cencini
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, Viale Bracci, 16, 53100, Siena, Italy. .,University of Siena, Siena, Italy.
| | - Alberto Fabbri
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, Viale Bracci, 16, 53100, Siena, Italy
| | | | - Monica Bocchia
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, Viale Bracci, 16, 53100, Siena, Italy.,University of Siena, Siena, Italy
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10
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Defrancesco I, Arcaini L. Overview on the management of non-gastric MALT lymphomas. Best Pract Res Clin Haematol 2017; 31:57-64. [PMID: 29452667 DOI: 10.1016/j.beha.2017.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 12/15/2022]
Abstract
Extranodal marginal zone B-cell lymphomas (EMZLs) of the mucosa-associated lymphoid tissue (MALT) are indolent lymphomas which can present at any extranodal site. The most frequent localizations (other than stomach) are ocular adnexa, salivary gland, skin, lung and thyroid. Chronic inflammation and antigenic stimulation are a potential risk for the development of MALT lymphomas. While Helicobacter Pylori (HP) is known to be associated with gastric MALT lymphoma and antibiotic therapy is effective in the setting of HP-positive, other microorganisms (such as Chlamydophila Psittaci, Campylobacter Jejiuni, Borrelia Burgdoferi) have been implicated in the pathogenesis of non-gastric MALT lymphomas. However, antibiotic therapy has not been extensively investigated for the non-gastric type, except for ocular adnexal MALT lymphoma, which could benefit from an upfront treatment with doxycycline. Surgery, radiotherapy, Rituximab alone or in combination with chemotherapy and "chemo-free" approaches, including lenalidomide, have shown efficacy in the treatment of non-gastric MALT lymphomas.
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Affiliation(s)
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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11
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Albano D, Borghesi A, Bosio G, Bertoli M, Maroldi R, Giubbini R, Bertagna F. Pulmonary mucosa-associated lymphoid tissue lymphoma: 18F-FDG PET/CT and CT findings in 28 patients. Br J Radiol 2017; 90:20170311. [PMID: 28830222 DOI: 10.1259/bjr.20170311] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of the study was to evaluate the CT and fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) imaging findings of lung mucosa associated lymphoid tissue (MALT) lymphoma. METHODS 28 patients with histologically confirmed pulmonary MALT lymphoma who underwent a chest CT and 18F-FDG PET/CT for staging were retrospectively analysed. The CT images were evaluated to determine morphological pattern of appearance, laterality, localization, number, size, presence of thoracic lymphadenopaties and secondary/combined findings. PET images were analysed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio and lesion-to-blood pool SUVmax ratio. The relationship between qualitative and semi-quantitative features at 18F-FDG PET/CT and CT findings were also analysed. RESULTS A total of 57 pulmonary lesions were identified by CT: 37 areas of consolidation, 4 masses, 12 nodules and 4 ground-glass opacities. Solitary and multiple lesions were detected in 10 and 18 patients, respectively; among patients with multiple lesions, 16 were bilateral and 2 unilateral. 18F-FDG PET/CT revealed increased 18F-FDG uptake in 47/57 lesions, in 26/28 patients. 18F-FDG avidity was significantly associated only with tumour size. CONCLUSIONS Pulmonary MALT lymphoma is 18F-FDG avid in most cases and 18F-FDG avidity is correlated with tumour size. Consolidation is the most frequent morphological pattern of disease presentation. Advances in knowledge: This study demonstrated that lung MALT lymphoma are 18F-FDG avid in most cases depending on tumour size. Single or multiple areas of consolidation are the most common pattern of presentation of lung MALT lymphoma at CT.
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Affiliation(s)
| | - Andrea Borghesi
- 2 Department of Radiology, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Giovanni Bosio
- 1 Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
| | - Mattia Bertoli
- 1 Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
| | - Roberto Maroldi
- 2 Department of Radiology, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Raffaele Giubbini
- 3 Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- 3 Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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12
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Lee H, Yang B, Nam B, Jeong BH, Shin S, Zo JI, Shim YM, Kwon OJ, Lee KS, Kim H. Treatment outcomes in patients with extranodal marginal zone B-cell lymphoma of the lung. J Thorac Cardiovasc Surg 2017; 154:342-349. [PMID: 28457544 DOI: 10.1016/j.jtcvs.2017.03.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 02/10/2017] [Accepted: 03/05/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate clinical presentations, treatment modalities, and outcomes of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma by stage strata. METHODS We retrospectively reviewed 51 patients diagnosed with pulmonary MALT lymphoma between January 2003 and December 2015. To compare treatment modalities and outcomes, we stratified the patients into low-stage (IE/IIE) and high-stage (IIIE/IVE) groups using modified Ann Arbor staging. Progression-free survival was estimated using Kaplan-Meier curves, and differences were compared using the log-rank test. A hazard ratio of progression by stage strata, adjusted for other clinical variables, was determined using a Cox adjusted proportional hazards model. RESULTS The majority of patients had stage IE disease (76.5%; 39 of 51). With advancing stage, patients were more likely to have respiratory and B symptoms and higher International Prognostic Index scores. The most common treatment modality was surgical resection in low-stage patients (33 of 43) and chemotherapy in high-stage patients (7 of 8). At a median follow-up of 40.7 months, progression-free survival was longer for low-stage patients (median, 40.7 months vs 24.9 months; P < .001), and high-stage patients were 9.2 times more likely to progress (hazard ratio, 9.24; 95% confidence interval, 1.93-44.36). Among 30 patients with surgically resected stage IE disease, 8 with central lesions were treated via lobectomy and 22 with peripheral lesions were treated via lobectomy (n = 8) or limited resection (n = 14). One of these patients, with a central lesion, experienced disease recurrence. CONCLUSIONS Our findings suggest that the clinical course of low-stage pulmonary MALT lymphoma, for which the mainstay of treatment is surgical resection, might be indolent.
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Affiliation(s)
- Hyun Lee
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bumhee Yang
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boda Nam
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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13
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Haroon J, Paul S. Living on the edge: Does cut mean cure for pulmonary mucosa-associated lymphoid tissue? J Thorac Cardiovasc Surg 2017; 154:350-351. [PMID: 28457541 DOI: 10.1016/j.jtcvs.2017.03.097] [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] [Received: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Junaid Haroon
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ
| | - Subroto Paul
- Department of Cardiothoracic Surgery, Saint Barnabas Medical Center, Newark Beth Israel Hospital, RWJBarnabas Health, Livingston, NJ.
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Wei Z, Li J, Cheng Z, Yuan L, Liu P. A single center experience: rituximab plus cladribine is an effective and safe first-line therapy for unresectable bronchial-associated lymphoid tissue lymphoma. J Thorac Dis 2017; 9:1081-1092. [PMID: 28523163 DOI: 10.21037/jtd.2017.03.81] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bronchial-associated lymphoid tissue (BALT) lymphoma is a relatively rare form of B-cell non-Hodgkin lymphoma (B-NHL). To date, the standard systemic treatment for this disease is still under debate, and few data are accessible for newly diagnosed unresectable BALT lymphoma presented with advanced disease. The combination of rituximab (R) and cladribine (2-CdA) has shown some activity in indolent B-NHL, but its usage has not been tested in disseminated BALT lymphoma so far. METHODS An observational retrospective study was performed on homogeneous data of 8 patients with biopsy-proven stage IV BALT lymphoma to assess the efficacy and the safety of R-2-CdA therapy. All but one of the patients received six courses of R-2-CdA regimen consisted of rituximab 375 mg/m2 IV day 1 and cladribine 0.1 mg/kg IV days 1-4 every 21 days; one patient completed 4 cycles and received additional R maintenance. RESULTS A high overall response rate (ORR) was observed (100%), with 2 patients (25%) achieved a complete remission (CR), the remaining (75%) a partial response. Improvement of pulmonary function was observed in all tested patients. Grade 3 and 4 toxicities were leukocytopenia and neutropenia in 3 patients (37.5%), diarrhea in one (12.5%). Estimated two-year progression-free survival (PFS) and 2-yr overall survival (OS) were 80.0% (95% CI, 20.3-96.7%) and 100%, respectively. CONCLUSIONS R-2-CdA therapy demonstrated high activity and tolerable toxicity in chemotherapy-naïve patients with unresectable BALT lymphoma of advanced stage. Although further large-scale study is needed for consolidation, R-2-CdA regimen could be a good first-line therapy option for patients with unresectable BALT lymphoma.
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Affiliation(s)
- Zheng Wei
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Li
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhixiang Cheng
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ling Yuan
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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15
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Matutes E, Montalban C. Clinical features and management of non-gastrointestinal non-ocular extranodal mucosa associated lymphoid tissue (ENMALT) marginal zone lymphomas. Best Pract Res Clin Haematol 2016; 30:99-108. [PMID: 28288723 DOI: 10.1016/j.beha.2016.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/09/2016] [Indexed: 02/07/2023]
Abstract
Extranodal mucosa associated lymphoid tissue (ENMALT) marginal zone lymphomas may arise at any site of the body. The most frequent localizations other than gastrointestinal and eye are salivary gland, skin, lung and thyroid. These lymphomas usually arise in a setting of inflammation due to a persistent infection or autoimmune diseases such as Sjogren syndrome in salivary MALT lymphomas and Hashimoto's thryroiditis in thyroid lymphomas. They affect middle-aged patients with a female predominance when lymphoma arises in certain locations. Patients often present with localised stage I or II although disseminated disease may be present at diagnosis or relapse in a third of the cases. Biopsy of the affected site is mandatory to establish the diagnosis and a full work-up staging is recommended. The clinical course is indolent and prognosis is good despite that recurrences following response to therapy are frequent. Surgery, radiotherapy and/or Rituximab based regimens are effective in these lymphomas.
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Affiliation(s)
| | - Carlos Montalban
- Department of Hematology, MD Anderson Cancer Center, Madrid, Spain.
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Abstract
PURPOSE OF REVIEW Despite the fact that primary pulmonary lymphoma (PPL) is a rare lung tumour, significant advances addressing clinical features, histological diagnosis, prognostic criteria and therapeutic management of this disease have been made within the past decade. RECENT FINDINGS Monoclonality and phenotyping of alveolar lymphocytes are suggestive of mucosa-associated lymphoid tissue (MALT). Detection of MALT-1 gene rearrangements in bronchoalveolar fluid cells using fluorescence in-situ hybridization techniques helps to confirm the diagnosis of MALT PPL. Fine needle aspiration-computed tomography guided biopsies as well as transbronchial/cryobiopsies provide adequate tissue material for histological evaluation. Recent publications also provide a better appreciation of newer chemotherapeutic approaches, including fludarabine and mitoxantrone with or without ritubximab for the treatment of MALT, as well as complete surgical resection if local disease is present. Prognostic factors influencing survival and optimal therapy for MALT have not been well defined, but the use of tumour microvascular density appears promising. SUMMARY This review outlines the implications of recent findings for clinical practice and research progress of PPL. Larger, multicentre and well designed studies are imperative to optimize the current diagnostic and therapeutic approach for this disease.
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Abramson JS, Ferry JA, Muse VV, Lanuti M. Extranodal Marginal Zone Lymphoma Presenting As Miliary Lung Disease. J Clin Oncol 2016; 34:e27-30. [PMID: 24912892 DOI: 10.1200/jco.2013.50.6501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Kiesewetter B, Ferreri AJM, Raderer M. Chemoimmunotherapy for Mucosa-Associated Lymphoid Tissue-Type Lymphoma: A Review of the Literature. Oncologist 2015; 20:915-25. [PMID: 26156327 PMCID: PMC4524756 DOI: 10.1634/theoncologist.2015-0109] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/13/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Biological treatments, chemoimmunotherapy, and radiotherapy are associated with excellent disease control in both gastric and extragastric mucosa-associated lymphoid tissue (MALT) lymphomas. Systemic treatment approaches with both oral and i.v. agents are being increasingly studied, not only for patients with disseminated MALT lymphoma, but also for those with localized disease. To date, however, recommendations for the use of available systemic modalities have not been clearly defined. MATERIALS AND METHODS The present report reviews the current data on systemic treatment options for patients with MALT lymphoma and provides recommendations for their use in everyday practice. RESULTS Different chemotherapeutic agents, including anthracyclines, alkylators, and purine analogs, have been successfully tested in patients with MALT lymphoma. Reducing side effects while maintaining efficacy should be the main goal in treating these indolent lymphomas. From the data from the largest trial performed to date, the combination of chlorambucil plus rituximab (R) appears to be active as first-line treatment. Similarly, R-bendamustine also seems to be highly effective, but a longer follow-up period is needed. R-monotherapy results in lower remission rates, but seems a suitable option for less fit patients. New immunotherapeutic agents such as lenalidomide (with or without rituximab) or clarithromycin show solid activity but have not yet been validated in larger collectives. CONCLUSION Patients with MALT lymphoma should be treated within prospective trials to further define optimal therapeutic strategies. Systemic treatment is a reasonable option with potentially curative intent in everyday practice. Based on the efficacy and safety data from available studies, the present review provides recommendations for the use of systemic strategies.
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Affiliation(s)
- Barbara Kiesewetter
- Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria; Unit of Lymphoid Malignancies, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Andrés J M Ferreri
- Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria; Unit of Lymphoid Malignancies, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Markus Raderer
- Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria; Unit of Lymphoid Malignancies, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
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BI LINTAO, LI JUN, DAN WANG, LU ZHENXIA. Pulmonary MALT lymphoma: A case report and review of the literature. Exp Ther Med 2015; 9:147-150. [PMID: 25452791 PMCID: PMC4247291 DOI: 10.3892/etm.2014.2072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal low-grade B-cell lymphoma. Pulmonary MALT lymphoma is considered to originate from bronchial MALT and is also referred to as bronchial-associated lymphoid tissue lymphoma. Pulmonary MALT lymphoma is a rare disease, but it is the most frequent subset of primary pulmonary lymphoma. The median age at diagnosis of pulmonary MALT lymphoma is 50-60 years, with only few patients aged <30 years. This is the case report of a 19-year-old patient with pulmonary MALT lymphoma presenting with a multiple pulmonary consolidation pattern on computed tomography scans, who underwent successful chemotherapeutic treatment with a chlorambucil-based regimen.
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Affiliation(s)
- LINTAO BI
- Department of Hematology and Oncology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130033, P.R. China
| | - JUN LI
- Department of Hematology and Oncology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130033, P.R. China
| | - WANG DAN
- Department of Hematology and Oncology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130033, P.R. China
| | - ZHENXIA LU
- Department of Hematology and Oncology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130033, P.R. China
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Rituximab monotherapy as a first-line treatment for pulmonary mucosa-associated lymphoid tissue lymphoma. Int J Hematol 2014; 101:46-51. [PMID: 25378228 DOI: 10.1007/s12185-014-1694-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 01/22/2023]
Abstract
Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare extranodal lymphoma with a 5-year survival rate of 80-95 %. There is no standard treatment strategy for pulmonary MALT lymphoma. In the present study, we performed a retrospective evaluation of systemic rituximab monotherapy (375 mg m(-2) day(-1), 4-8 cycles) as first-line treatment in patients with pulmonary MALT lymphoma. Of the eight patients enrolled, five achieved complete response, one achieved partial response, and two showed stable disease. Median progression-free survival was 66.0 months (range 9.7-87.2 months). Treatment was well tolerated and all patients were alive during the median follow-up period of 64.0 months. Rituximab monotherapy was efficacious in patients with pulmonary MALT lymphoma, demonstrating long-term disease stabilization and symptom reduction. Larger prospective studies are warranted to further assess the efficacy of rituximab monotherapy. In conclusion, rituximab monotherapy may be considered for first-line therapy in patients with pulmonary MALT lymphoma.
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Detection rate of fluorine-18-fluorodeoxyglucose positron emission tomography in patients with marginal zone lymphoma of MALT type: a meta-analysis. Hematol Oncol 2014; 33:113-24. [DOI: 10.1002/hon.2152] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/09/2014] [Indexed: 01/03/2023]
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