1
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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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2
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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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3
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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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4
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Archibald WJ, Baran AM, Williams AM, Salloum RM, Richard Burack W, Evans AG, Syposs CR, Zent CS. The role of splenectomy in management of splenic B-cell lymphomas. Leuk Res 2023; 128:107053. [PMID: 36906942 DOI: 10.1016/j.leukres.2023.107053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Splenic B-cell lymphomas are rare and understudied entities. Splenectomy is frequently required for specific pathological diagnosis in patients with splenic B-cell lymphomas other than classical hairy cell leukemia (cHCL), and can be effective and durable therapy. Our study investigated the diagnostic and therapeutic role of splenectomy for non-cHCL indolent splenic B-cell lymphomas. METHODS Observational study of patients with non-cHCL splenic B-cell lymphoma undergoing splenectomy between 1 August 2011 and 1 August 2021 at the University of Rochester Medical Center. The comparison cohort was patients categorized as having non-cHCL splenic B-cell lymphoma who did not undergo splenectomy. RESULTS Forty-nine patients (median age 68 years) had splenectomy (SMZL n = 33, HCLv n = 9, SDRPL n = 7) with median follow up of 3.9 years post splenectomy. One patient had fatal post-operative complications. Post-operative hospitalization was ≤ 4 days for 61% and ≤ 10 days for 94% of patients. Splenectomy was initial therapy for 30 patients. Of the 19 patients who had previous medical therapy, splenectomy changed their lymphoma diagnosis in 5 (26%). Twenty-one patients without splenectomy were clinically categorized as having non-cHCL splenic B-cell lymphoma. Nine required medical treatment for progressive lymphoma and of these 3 (33%) required re-treatment for lymphoma progression compared to 16% of patients following first line splenectomy. CONCLUSION Splenectomy is useful for the diagnosis of non-cHCL splenic B-cell lymphomas with comparable risk/benefit profile and remission duration to medical therapy. Patients with suspected non-cHCL splenic lymphomas should be considered for referral to a high-volume center with experience in performing splenectomies for definitive diagnosis and treatment.
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Affiliation(s)
- William J Archibald
- James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Andrea M Baran
- James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - AnnaLynn M Williams
- James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Rabih M Salloum
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - W Richard Burack
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Andrew G Evans
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Chauncey R Syposs
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Clive S Zent
- James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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5
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Qualls D, Kumar A, Epstein-Peterson Z. Targeting the immune microenvironment in mantle cell lymphoma: implications for current and emerging therapies. Leuk Lymphoma 2022; 63:2515-2527. [PMID: 35704674 PMCID: PMC9741766 DOI: 10.1080/10428194.2022.2086244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
Mantle cell lymphoma (MCL) is a morphologically and phenotypically heterogeneous subtype of non-Hodgkin lymphoma, and has historically been associated with poor outcomes. However, recent advances in our understanding of this disease have yielded new targeted and immune-based therapies with promising activity. Immune-based therapies such as monoclonal antibodies, immunomodulators, and CAR T cells have significantly improved outcomes and are now standard of care in MCL. In this review, we describe our current understanding of the immune microenvironment of MCL, discuss current immunotherapeutic approaches, and highlight promising novel immune-based therapies and combination therapies that may further improve outcomes for patients with MCL.
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Affiliation(s)
- David Qualls
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center. New York, NY, USA
| | - Anita Kumar
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center. New York, NY, USA
| | - Zachary Epstein-Peterson
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center. New York, NY, USA
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6
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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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7
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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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8
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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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9
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Silva L, Alpoim M, Ribeiro A, Caiano Gil P, Lopes Caçola R. Hepatic Infiltration by Splenic Marginal Zone Lymphoma in a Patient With Cured Hepatitis C. Cureus 2021; 13:e18667. [PMID: 34786250 PMCID: PMC8579832 DOI: 10.7759/cureus.18667] [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] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
Abstract
Splenic marginal zone lymphoma (SMZL) accounts for only 1-2.7% of all lymphomas. Almost all patients have bone marrow (BM) involvement but only one-third has liver involvement. The higher prevalence of hepatitis C virus (HCV) infection in these patients has led to the hypothesis of viral involvement in lymphomagenesis. In this report, we present a case of a 48-year-old woman, with cured hepatitis C, presenting with fever, weight loss, nausea, abdominal pain, and jaundice. She had leucocytosis with lymphocytosis, a progressively worsening cytocholestasis, and hepatosplenomegaly. Liver biopsy, immunophenotyping, and BM biopsy were performed, resulting in the diagnosis of SMZL. The patient started chemotherapy (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone) with an initial good response, but later progression to high-grade lymphoma and was recommended to undergo salvage chemotherapy followed by auto-transplant. Despite the unusual liver involvement, we should consider hepatic infiltration by lymphomas, such as SMZL, especially in patients with a history of HCV infection.
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Affiliation(s)
- Leonor Silva
- Internal Medicine, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Mafalda Alpoim
- Hematology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Ana Ribeiro
- Pathology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Pedro Caiano Gil
- Internal Medicine, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Rute Lopes Caçola
- Internal Medicine, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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10
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Bastidas-Mora G, Beà S, Navarro A, Gine E, Costa D, Delgado J, Baumann T, Magnano L, Rivas-Delgado A, Villamor N, Colomer D, Lopez-Guerra M, Rozman M, Balagué O, Martínez D, Baptista MJ, Escoda L, Alcoceba M, Blanes M, Climent F, Campo E, Wotherspoon A, López-Guillermo A, Matutes E. Clinico-biological features and outcome of patients with splenic marginal zone lymphoma with histological transformation. Br J Haematol 2021; 196:146-155. [PMID: 34519021 PMCID: PMC9292151 DOI: 10.1111/bjh.17815] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/04/2022]
Abstract
We describe 36 patients with splenic marginal zone lymphoma (SMZL) with transformation (SMZL‐T), including 15 from a series of 84 patients with SMZL diagnosed at the Hospital Clinic of Barcelona (HCB) and 21 diagnosed with SMZL‐T in other centres. In the HCB cohort, the cumulative incidence of transformation at 5 years was 15%. Predictors for transformation were cytopenias, hypoalbuminaemia, complex karyotype (CK) and both the Intergruppo Italiano Linfomi (ILL) and simplified Haemoglobin, Platelet count, lactate dehydrogenase (LDH) and extrahilar Lymphadenopathy (HPLL)/ABC scores (P < 0·05). The only independent predictor for transformation in multivariate analysis was CK [hazard ratio (HR) 4·025, P = 0·05]. Patients with SMZL‐T had a significantly higher risk of death than the remainder (HR 3·89, P < 0·001). Of the 36 patients with SMZL‐T, one developed Hodgkin lymphoma and 35 a diffuse large B‐cell lymphoma, 71% with a non‐germinal centre phenotype. The main features were B symptoms, lymphadenopathy, and high serum LDH. CK was observed in 12/22 (55%) SMZL‐T and fluorescence in situ hybridisation detected abnormalities of MYC proto‐oncogene, basic helix‐loop‐helix transcription factor (MYC), B‐cell leukaemia/lymphoma 2 (BCL2) and/or BCL6 in six of 14 (43%). In all, 21 patients received immunochemotherapy, six chemotherapy, one radiotherapy and three splenectomy. The complete response (CR) rate was 61% and the median survival from transformation was 4·92 years. Predictors for a worse survival in multivariate analysis were high‐risk International Prognostic Index (HR 5·294, P = 0·016) and lack of CR (HR 2·67, P < 0·001).
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Affiliation(s)
- Gabriela Bastidas-Mora
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Sílvia Beà
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Alba Navarro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Eva Gine
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Dolors Costa
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Julio Delgado
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Tycho Baumann
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Servicio de Hematología, Hospital 12 de Octubre, Madrid, Spain
| | - Laura Magnano
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Rivas-Delgado
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Neus Villamor
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Dolors Colomer
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Mónica Lopez-Guerra
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - María Rozman
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Olga Balagué
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Daniel Martínez
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Maria Joao Baptista
- ICO-Hospital Germans Trias I Pujol- Josep Carreras Leukaemia Research Institute (IJC), Barcelona, Spain
| | | | - Miguel Alcoceba
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Hematology, Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), University Hospital of Salamanca (HUS/IBSAL), Salamanca, Spain
| | | | - Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Elías Campo
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | | | - Armando López-Guillermo
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Estella Matutes
- Hematology Department and Hematopathology Section, Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain
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11
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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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12
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Ollila TA, Olszewski AJ. Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma. Cancer Manag Res 2021; 13:3935-3952. [PMID: 34017197 PMCID: PMC8131013 DOI: 10.2147/cmar.s267258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Many patients with follicular (FL) or marginal zone lymphoma (MZL) are not eligible to receive immunochemotherapy due to advanced age or comorbidities. Recent innovations in the treatment of these indolent lymphomas provide options for multiple lines of chemotherapy-free management. More research is needed to determine which older patients are best served by a chemotherapy-free approach in the context of geriatric vulnerabilities. In the first line, regardless of disease burden, rituximab monotherapy can provide high rates of disease control with minimal toxicity, while judicious use of brief maintenance extends the duration of response. Radioimmunotherapy using ibritumomab tiuxetan is an effective and safe post-rituximab consolidation for older patients who have <25% bone marrow involvement. The combination of rituximab and lenalidomide, although "chemotherapy-free", does not improve tolerability over immunochemotherapy. However, studies support lower doses and shorter duration of lenalidomide exposure as a means to improve safety without materially compromising efficacy for older individuals. Extranodal MZL can often be effectively controlled with low-dose radiation therapy, and splenic MZL has excellent outcomes with rituximab monotherapy. For many patients with relapsed FL/MZL, simple retreatment with anti-CD20 antibodies will prove sufficient. Other currently available options for relapsed/refractory disease include ibritumomab tiuxetan, lenalidomide with rituximab, umbralisib as a potentially less toxic PI3K inhibitor, ibrutinib (for MZL), and tazemetostat (for FL, especially with EZH2 mutation). Emerging data with novel forms of immunotherapy (antibody-drug conjugates like polatuzumab vedotin or loncastuximab tesirine; T-cell-engaging bispecific antibodies like mosunetuzumab or epcoritamab; and chimeric antigen receptor CAR T-cells like axicabtagene ciloleucel) suggest that immune-directed approaches can produce very high and potentially durable responses in FL/MZL with limited toxicities, further obviating the need for chemotherapy.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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13
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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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14
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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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15
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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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16
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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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17
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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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18
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Juárez-Salcedo LM, Conde-Royo D, Quiroz-Cervantes K, Dalia S. Use of anti-CD20 therapy in follicular and marginal zone lymphoma: a review of the literature. Drugs Context 2020; 9:2019-9-3. [PMID: 32426017 PMCID: PMC7216786 DOI: 10.7573/dic.2019-9-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/13/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
The identification of the CD20 antigen in 1979 was the first step in what would become a therapeutic milestone opening the use of immunotherapy in hematological diseases. This protein is expressed on the surface of developing B cells, but not the early progenitors or mature plasma cells. In 1997, rituximab was approved by the Food and Drug Administration, and since then it has revolutionized the treatment of B-cell malignancies. It is used as a monotherapy and in combination, at induction, at relapsed, and also in maintenance. Indolent non-Hodgkin lymphomas are characterized by a long and non-aggressive course. In this group of lymphomas, rituximab represented a great therapeutic improvement, achieving lasting responses with few adverse effects. Nowadays, second-generation molecules are emerging that may have important advantages compared to rituximab, as well as biosimilars that represent an important cost-effective option.
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Affiliation(s)
| | - Diego Conde-Royo
- Hematology Department, Principe de Asturias General Hospital, Madrid, Spain
| | | | - Samir Dalia
- Hematology/Oncology Department, Mercy Clinic Oncology and Hematology – Joplin, Missouri, United States
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19
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Successful Surgical Removal of the Largest Known Spleen. Case Rep Surg 2020; 2020:6790808. [PMID: 32158587 PMCID: PMC7061101 DOI: 10.1155/2020/6790808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022] Open
Abstract
Background Splenic marginal zone lymphoma (SMZL) is a rare subtype of non-Hodgkin lymphoma that typically presents with symptomatic splenomegaly. The optimal treatment of SMZL not well established. Case Presentation. A 44-year-old man with a history of low-grade B-cell lymphoproliferative disorder previously treated with chemotherapy presented with a three-month history of rapidly enlarging abdominal girth. He was found to have large symptomatic splenomegaly by computed tomography. After workup, he underwent preoperative angioembolization of the splenic artery followed by successful splenectomy. The spleen measured 45 cm in greatest dimension and weighed 12.14 kg, more than 12% of the patient's total body weight, making this both the largest spleen on record as well as the largest spleen ever surgically removed. Pathology was consistent with splenic marginal zone lymphoma. The patient did well and was discharged home on postoperative day 3. Conclusions SMZL is an infrequent condition that leads to progressive symptomatic splenomegaly which can be managed surgically providing symptomatic improvement and an overall satisfactory oncologic outcome. A multidisciplinary approach to complex cases of SMZL splenomegaly is imperative to achieving optimal outcomes.
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20
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Tracy SI, Larson MC, Feldman AL, Maurer MJ, Novak AJ, Slager SL, Villasboas JC, Allmer C, Habermann TM, Farooq U, Syrbu S, Cerhan JR, Link BK. The utility of prognostic indices, early events, and histological subtypes on predicting outcomes in non-follicular indolent B-cell lymphomas. Am J Hematol 2019; 94:658-666. [PMID: 30916801 DOI: 10.1002/ajh.25473] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
Indolent B-cell lymphomas other than follicular lymphoma account for up to 10% of all B-cell neoplasms. While they typically follow a slowly progressive course, some patients experience rapid progression and early mortality. Prognostic scoring systems have not been adopted, hindering the ability of clinicians or researchers to predict outcomes, or risk-stratify patients during clinical trials. To address this, we evaluated the utility of existing prognostic indices and novel, early disease-related outcomes, to predict subsequent long term survival. Baseline characteristics and outcomes data were generated from a longitudinal cohort study that prospectively enrolled 632 patients newly diagnosed with marginal zone lymphoma, lymphoplasmacytic lymphomas, or B-cell lymphomas not otherwise specified, beginning in 2002. The International Prognostic Index (IPI), Follicular Lymphoma International Prognostic Index (FLIPI), and MALT International prognostic index (MALT-IPI) demonstrated c-statistics that ranged from 0.593-0.612 for event-free survival (EFS), and 0.683-0.714 for overall survival (OS). Patients who attained event-free survival at 12 months (EFS12) experienced similar mortality to the US general population (standardized mortality ratio [SMR] 1.19; 95% CI 0.95-1.46). Patients who did not attain EFS12 had subsequent worse morality (SMR 3.14 (95% CI 2.05-4.59). The MALT-IPI demonstrated utility in predicting subsequent long-term outcomes among patients with non-follicular indolent B-cell lymphomas. This index should be used by clinicians giving guidance to patients at the time of initial diagnosis, and risk stratification during clinical studies. The divergent long-term outcomes experienced by patients who do or do not attain EFS12 suggest there exists a subset of patients who harbor high-risk disease. Future research efforts should focus on methods to identify these patients at the time of diagnosis, in order to enable risk-tailored therapy.
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Affiliation(s)
- Sean I. Tracy
- Division of Hematology, Oncology, and Bone Marrow TransplantationUniversity of Minnesota Minneapolis Minnesota
| | | | | | | | - Anne J. Novak
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Susan L. Slager
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Cristine Allmer
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Umar Farooq
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
| | - Sergei Syrbu
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
| | - James R. Cerhan
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Brian K. Link
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
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Fallah J, Olszewski AJ. Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base. Hematology 2019. [DOI: 10.1080/16078454.2019.1591570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jaleh Fallah
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Adam J. Olszewski
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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22
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Oliveira LC, Fardilha C, Louro M, Pinheiro C, Sousa A, Marques H, Costa P. Palliative splenic irradiation for symptomatic splenomegaly in non-Hodgkin lymphoma. Ecancermedicalscience 2018; 12:887. [PMID: 30792804 PMCID: PMC6351061 DOI: 10.3332/ecancer.2018.887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION AND AIMS Splenic marginal zone lymphoma, an uncommon subtype of non-Hodgkin lymphoma (NHL), is usually present with symptomatic splenomegaly. Although splenectomy has long been considered the first-line therapy in symptomatic or cytopenic patients, it can lead to significant morbidity and mortality. Splenic irradiation is an option for patients who have a poor response to systemic therapy and/or are not surgical candidates. In this paper, we present a case report of a patient who received splenic radiotherapy for symptomatic splenomegaly. METHODS An 85-year-old Caucasian man with a 4 year history of low-grade NHL presented with progressive pancytopenia, significant weight loss and symptomatic splenomegaly (abdominal discomfort, sense of fullness and limitation of mobility due to spleen size). The patient refused splenectomy and, in December 2017, was referred to palliative splenic radiotherapy. He was initially treated with five fractions of one Grey (Gy) in order to evaluate clinical and haematology response. After that, 1.5 Gy daily, 5 days a week for 3 weeks. 3D conformal radiotherapy, multiple fields and mixed energy (6 and 15 Mv) were used. RESULTS Radiotherapy allowed significant splenic reduction to almost half the size, resolving abdominal discomfort and improving quality of life. There was no decline of haemoglobin, leukocytes and platelet counts; in fact, there was a marginal increase. CONCLUSION Palliative splenic irradiation was well tolerated confirming that it is a safe treatment option for palliation of symptomatic splenomegaly. Thereby, splenic irradiation should be strongly considered in the management of symptomatic splenomegaly, for selected patients who are refractory to or unsuitable for other options or when the patient refuses other treatments.
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Affiliation(s)
| | - Carlos Fardilha
- Department of Radiation Oncology, Hospital de Braga, Braga, Portugal
| | - Manuel Louro
- Department of Radiation Oncology, Hospital de Braga, Braga, Portugal
| | - Carlos Pinheiro
- Department of Radiation Oncology, Hospital de Braga, Braga, Portugal
| | - Abílio Sousa
- Department of Radiation Oncology, Hospital de Braga, Braga, Portugal
| | - Herlander Marques
- Department of Oncology, Hospital de Braga, Braga, Portugal
- Clinical Academic Centre, Braga, Portugal
- Centre for Health Technology and Services Research, Porto, Portugal
| | - Paulo Costa
- Department of Radiation Oncology, Hospital de Braga, Braga, Portugal
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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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24
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Avivi I, Arcaini L, Ferretti VV, Boumendil A, Finel H, Milone G, Zaja F, Liliana D, Musso M, Didier B, Bachy E, Wattad M, Nicolas-Virelizier E, Gramatzki M, Bourhis JH, Caillot D, Haenel A, Held G, Thieblemont C, Jindra P, Pohlreich D, Guilhot F, Kroschinsky F, Wahlin B, Scheid C, Ifrah N, Berthou C, Dreger P, Montoto S, Conconi A. High-dose therapy and autologous stem cell transplantation in marginal zone lymphomas: a retrospective study by the EBMT Lymphoma Working Party and FIL-GITMO. Br J Haematol 2018; 182:807-815. [PMID: 29984825 DOI: 10.1111/bjh.15454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/18/2018] [Indexed: 12/26/2022]
Abstract
The role of autologous stem cell transplantation (ASCT) in patients with marginal zone lymphoma (MZL) is debatable. This study investigated the outcome and prognostic factors affecting the outcome of patients undergoing ASCT for MZL. Eligible patients had non-transformed nodal, extra-nodal (MALT) or splenic MZL (SMZL), aged ≥18 years, who underwent a first ASCT between1994 and 2013 and were reported to the European Society for Blood and Marrow Transplantation, Fondazione Italiana Linfomi or Gruppo Italiano Trapianto Di Midollo Osseo registries. The study included 199 patients, [111 MALT lymphoma, 55 nodal MZL (NMZL) and 33 SMZL]. Median age at transplantation was 56 years. The median number of prior therapies was 2 (range 1-8), including rituximab in 71%. 95% had chemosensitive disease. 89% received a chemotherapy-based high-dose regimen. There were no significant differences in patient and transplant characteristics between the 3 histological subtypes except for a lower percentage of patients previously treated with rituximab in the MALT sub-group and more transplants performed in recent years in the other sub-groups. After a median follow-up of 5 years, 5-year cumulative incidence of relapse/progression and non-relapse mortality were 38% and 9%, respectively. Five-year event-free survival (EFS) and overall survival (OS) were 53% and 73%, respectively. Five-year cumulative incidence of second malignancies was 6%. Multivariate analysis revealed age ≥65 years was associated with a shorter EFS and OS. In addition, patients with SMZL had a shorter OS than those with MALT. ASCT may provide clinical benefit in MZL patients who have failed multiple lines of chemoimmunotherapy.
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Affiliation(s)
- Irit Avivi
- Tel Aviv Sourasky Medical Centre, Tel-Aviv, Israel
| | - Luca Arcaini
- Universita Di Pavia, IRCCS Fondazione San Matteo, Pavia, Italy
| | | | | | - Hervé Finel
- EBMT LWP Paris Office, Hôpital Saint-Antoine, Paris, France
| | - Giuseppe Milone
- Institute of Hematology, University of Catania, Catania, Italy
| | | | - Devizzi Liliana
- Division of Medical Oncology, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Blaise Didier
- Département d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France
| | - Emmanuel Bachy
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Martin Gramatzki
- University Hospital Schleswig-Holstein, Kiel, Germany.,University of Kiel, Kiel, Germany
| | | | | | | | - Gerhard Held
- Department of Internal Medicine I, Saarland University Medical School, Homburg/Saar, Germany.,University Hospital of Saarland, Homburg, Germany
| | - Catherine Thieblemont
- APHP - INSERM U 728 - Institut Universitaire d'Hematologie, Hopital Saint-Louis, Paris, France
| | | | | | | | - Frank Kroschinsky
- Midizinische Klinik und Poliklinik I, Universitaetsklinikum Dresden, Dresden, Germany
| | - Björn Wahlin
- Department of Medicine, Huddinge (MedH), H7, Unit for Hematology, M 54, Karolinska Universitetssjukhuset Huddinge, Stockholm, Sweden
| | | | | | | | - Peter Dreger
- EBMT LWP Paris Office, Hôpital Saint-Antoine, Paris, France.,University of Heidelberg, Heidelberg, Germany
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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25
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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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26
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27
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Denlinger NM, Epperla N, William BM. Management of relapsed/refractory marginal zone lymphoma: focus on ibrutinib. Cancer Manag Res 2018; 10:615-624. [PMID: 29628774 PMCID: PMC5877869 DOI: 10.2147/cmar.s133291] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Marginal zone lymphomas (MZLs) consist of a diverse family of malignancies, which are derived from B-cells. The disease subtypes are recognized extranodal, nodal, and splenic MZLs. The disease characteristics, clinical course, and treatment vary considerably based on the site of involvement. In 2017, the US Food and Drug Administration approved ibrutinib, a first in class Bruton’s tyrosine kinase inhibitor that revolutionized the care of chronic lymphocytic leukemia patients; for, the treatment of relapsed/refractory MZL based on pivotal open-label Phase II trial demonstrated an overall response rate of 48%, with a complete response rate of 3%, median progression-free survival of 14.2 months, and median overall survival not yet reached at a median follow-up of 19.4 months. In this review, we aim to summarize the current conundrums in the management of MZL and the evolving role of ibrutinib in the treatment of MZL.
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Affiliation(s)
- Nathan M Denlinger
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center (OSUCCC-James), The Ohio State University, Columbus, OH, USA
| | - Narendranath Epperla
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center (OSUCCC-James), The Ohio State University, Columbus, OH, USA
| | - Basem M William
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center (OSUCCC-James), The Ohio State University, Columbus, OH, USA
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28
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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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29
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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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30
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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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31
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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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32
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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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Abstract
B-cell non-Hodgkin lymphomas with plasmacytic differentiation are a diverse group of entities with extremely variable morphologic features. Diagnostic challenges can arise in differentiating lymphoplasmacytic lymphoma from marginal zone lymphoma and other low-grade B-cell lymphomas. In addition, plasmablastic lymphomas can be difficult to distinguish from diffuse large B-cell lymphoma or other high-grade lymphomas. Judicious use of immunohistochemical studies and molecular testing can assist in appropriate classification.
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MESH Headings
- Diagnosis, Differential
- Humans
- Immunophenotyping
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Plasmacytoma/diagnosis
- Plasmacytoma/immunology
- Plasmacytoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Prognosis
- Waldenstrom Macroglobulinemia/diagnosis
- Waldenstrom Macroglobulinemia/immunology
- Waldenstrom Macroglobulinemia/pathology
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Affiliation(s)
- Charles M Harmon
- Department of Pathology, University of Michigan Hospitals and Health Systems, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Lauren B Smith
- Department of Pathology, University of Michigan Hospitals and Health Systems, 5320 Medical Science I, 1301 Catherine Street, Ann Arbor, MI 48109-5602, USA.
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Piris MA, Onaindía A, Mollejo M. Splenic marginal zone lymphoma. Best Pract Res Clin Haematol 2016; 30:56-64. [PMID: 28288718 DOI: 10.1016/j.beha.2016.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 01/25/2023]
Abstract
Splenic marginal zone lymphoma (SMZL) is an indolent small B-cell lymphoma involving the spleen and bone marrow characterized by a micronodular tumoral infiltration that replaces the preexisting lymphoid follicles and shows marginal zone differentiation as a distinctive finding. SMZL cases are characterized by prominent splenomegaly and bone marrow and peripheral blood infiltration. Cells in peripheral blood show a villous cytology. Bone marrow and peripheral blood characteristic features usually allow a diagnosis of SMZL to be performed. Mutational spectrum of SMZL identifies specific findings, such as 7q loss and NOTCH2 and KLF2 mutations, both genes related with marginal zone differentiation. There is a striking clinical variability in SMZL cases, dependent of the tumoral load and performance status. Specific molecular markers such as 7q loss, p53 loss/mutation, NOTCH2 and KLF2 mutations have been found to be associated with the clinical variability. Distinction from Monoclonal B-cell lymphocytosis with marginal zone phenotype is still an open issue that requires identification of precise and specific thresholds with clinical meaning.
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Affiliation(s)
- Miguel A Piris
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Arantza Onaindía
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuela Mollejo
- Servicio de Anatomía Patológica, Hospital Virgen de la Salud, Toledo, Spain
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35
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Casulo C, Friedberg J. Transformation of marginal zone lymphoma (and association with other lymphomas). Best Pract Res Clin Haematol 2016; 30:131-138. [PMID: 28288708 DOI: 10.1016/j.beha.2016.08.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 12/18/2022]
Abstract
Marginal zone lymphomas (MZL) are a diverse group of indolent lymphoproliferative disorders that comprise three subtypes: nodal, splenic and mucosal associated marginal zone lymphomas (MALT). Histologic transformation (HT) to an aggressive lymphoma is a rare event that can occur in any subtype, and at lower frequency compared to other indolent non Hodgkin lymphomas (NHL) like follicular lymphoma. There are few data directly associated with risk and prognosis of transformation in MZL. However, recent advances in the understanding of molecular and genetic features of MALT have contributed to an evolving appreciation of HT in this disease. Optimal treatment of HT of MZL remains unknown. Much of the approach to managing transformed MZL is extrapolated from other indolent NHLs.
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Affiliation(s)
- Carla Casulo
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
| | - Jonathan Friedberg
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
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36
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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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Perrone S, D’Elia GM, Annechini G, Ferretti A, Tosti ME, Foà R, Pulsoni A. Splenic marginal zone lymphoma: Prognostic factors, role of watch and wait policy, and other therapeutic approaches in the rituximab era. Leuk Res 2016; 44:53-60. [DOI: 10.1016/j.leukres.2016.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/09/2016] [Accepted: 03/21/2016] [Indexed: 02/07/2023]
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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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Li Z, Li F, Yi S, Gu Z, Yu Z, Xu Y, Feng X, Liu W, Zou D, Qi J, Zhan F, Qiu L. Superior efficacy of rituximab-based chemoimmunotherapy as an initial therapy in newly diagnosed patients with B cell indolent lymphomas: long-term results from a single center in China. BMC Cancer 2015. [PMID: 26219471 PMCID: PMC4517647 DOI: 10.1186/s12885-015-1534-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Rituximab has been confirmed to improve the survival of patients with B cell indolent non-Hodgkin lymphomas (B-iNHLs) in Western world as previously reported, however, it is rarely reported in Chinese cohort. This study is to investigate the efficacy and safety of rituximab-based chemoimmunotherapy and select subpopulations most sensitive to the regimen in Chinese B-iNHL patients. Methods 334 B-iNHL patients from our center were retrospectively assessed. Results Patients received R-based chemoimmunotherapy showed significantly higher rates of overall response (OR) (93.0 % vs. 53.4 %, P < 0.001) and complete response (CR) (63.3 % vs. 16.0 %, P < 0.001) compared with the patients received other therapies. Survival analysis showed that rituximab-based chemoimmunotherapy could obviously improve the progression-free survival (PFS) (110 vs. 49 months, P = 0.001) and overall survival (OS) (120 vs. 72 months, P < 0.001) in patients with B-iNHLs. Interestingly, in chronic lymphocytic leukemia (CLL) patients, we found that the patients with β2-microglobulin (β2-MG) < 3.5 mg/L, lactate dehydrogenase (LDH) < 220 U/L, zeta-chain-associated protein kinase 70 (ZAP-70) negative, and non high-risk genetic abnormality could achieve more benefits from R-based regimens with higher CR rate (P = 0.003, 0.029, 0.013 and 0.038, respectively). Meanwhile, more CLL patients achieved minimal residual disease (MRD) negative after rituximab-based treatment (46.5 % vs. 10.3 %, P < 0.001). Moreover, CLL patients with MRD < 1 %, LDH < 220 U/L, complete remission (CR) or partial remission (PR), β2-MG < 3.5 mg/L and non high-risk cytogenetic abnormality showed superior outcome compared to the controls (P = 0.001, 0.000, 0.000, 0.001 and 0.013, respectively). No other side-effects increased in chemoimmunotherapy group except the elevation of grade 3–4 neutropenia. Conclusions Our results demonstrate the superior efficacy of rituximab–based chemoimmunotherapy as an initial therapy in Chinese cohort with newly diagnosed B-iNHLs and further identify subpopulations that are more sensitive to R-based chemoimmunotherapy in CLL group.
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Affiliation(s)
- Zengjun Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
| | - Fei Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China. .,Department of Hematology, The First Affiliated Hospital of Nanchang University, NanChang, 330006, China.
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
| | - Zhimin Gu
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52246, USA.
| | - Zhen Yu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
| | - Xiaoyan Feng
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
| | - Junyuan Qi
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
| | - Fenghuang Zhan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52246, USA.
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China. .,Umbilical Cord Blood Bank of Tianjin, Tianjin, 300020, China.
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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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Abstract
Marginal zone lymphomas (MZL) represent around 8 % of all non-Hodgkin lymphomas. During the last decades a number of studies have addressed the mechanisms underlying the disease development. Extranodal MZL lymphoma usually arises in mucosal sites where lymphocytes are not normally present from a background of either autoimmune processes, such as Hashimoto thyroiditis or Sjögren syndrome or chronic infectious conditions. In the context of a persistent antigenic stimulation, successive genetic abnormalities can progressively hit a B-cell clone among the reactive B-cells of the chronic inflammatory tissue and give rise to a MALT lymphoma. The best evidence of an etiopathogenetic link is available for the association between Helicobacter pylori-positive gastritis and gastric MALT lymphoma. Indeed, a successful eradication of this micro-organism with antibiotics can be followed by gastric MALT lymphoma regression in more than 2/3 of cases. Other microbial agents have been implicated in the pathogenesis of MZL arising in the skin (Borrelia burgdorferi), in the ocular adnexa (Chlamydophila psittaci), and in the small intestine (Campylobacter jejuni). The prevalence of hepatitis C virus (HCV) has also been reported higher in MZL patients (particularly of the splenic type) than in the control population, suggesting a possible causative role of the virus. In non-gastric MALT lymphoma and in splenic MZL the role of the antimicrobial therapy is, however, less clear. This review summarizes the recent advances in Marginal Zone Lymphomas, addressing the critical points in their diagnosis, staging and clinical management.
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A rare case of splenic marginal zone B-cell lymphoma mimicking relapsing polychondritis of the ear. Case Rep Otolaryngol 2014; 2014:139386. [PMID: 25544924 PMCID: PMC4269282 DOI: 10.1155/2014/139386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/04/2014] [Accepted: 11/10/2014] [Indexed: 11/24/2022] Open
Abstract
Relapsing polychondritis (RPC) is a poorly understood phenomenon associated with cartilaginous inflammation of the ear, nose, tracheobronchial tree, and peripheral joints. Many cases of RPC respond to anti-inflammatories and resolve with no further complications. However, RPC has also been linked to more insidious conditions such as malignancies, autoimmune disorders, vasculitis, or underlying infections. Given the spectrum of associated disorders, patients with RPC may need to be monitored for more insidious underlying conditions. In this case, we report a unique case of bilateral auricular inflammation and nasal inflammation mimicking RPC as the only presenting symptom of splenic marginal zone B-cell lymphoma and we survey related cases in the literature.
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Lupus anticoagulant and thrombosis in splenic marginal zone lymphoma. Thromb Res 2014; 134:980-4. [DOI: 10.1016/j.thromres.2014.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/30/2014] [Accepted: 08/21/2014] [Indexed: 12/26/2022]
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Zinzani PL, Pellegrini C, Broccoli A, Gandolfi L, Stefoni V, Casadei B, Maglie R, Argnani L, Pileri S. Fludarabine-Mitoxantrone-Rituximab regimen in untreated indolent non-follicular non-Hodgkin's lymphoma: experience on 143 patients. Hematol Oncol 2014; 33:141-6. [DOI: 10.1002/hon.2151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/04/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
| | - Cinzia Pellegrini
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
| | - Alessandro Broccoli
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
| | - Letizia Gandolfi
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
| | - Vittorio Stefoni
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
| | - Beatrice Casadei
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
| | - Roberto Maglie
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
| | - Lisa Argnani
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
| | - Stefano Pileri
- Institute of Hematology ‘L. e A. Seràgnoli’; University of Bologna; Bologna Italy
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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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