title: Prospective study of indolent non-follicular non-Hodgkin's lymphoma: validation of Gruppo Italiano per lo studio dei linfomi (GISL) prognostic criteria for watch and wait policy.
abstract: Only recently both the Revised European American Lymphoma (REAL) and World Health Organization (WHO) classifications clearly identified indolent non-follicular non-Hodgkin's lymphoma (NHL) as a distinct group of precise histological entities. Therefore, prognostic models, specifically designed for this NHL subset, are still lacking. In this study, we prospectically evaluated the prognostic criteria proposed by the Gruppo Italiano per lo studio dei linfomi (GISL) to identify patients with an indolent non-progressive clinical course, eligible for a watch and wait policy within this histological subset defined according to stringent criteria of histomorphology and immunophenotype. Fifty-three patients affected with small lymphocytic, marginal zone, lymphoplasmacytic lymphoma and lacking at presentation the following: B symptoms, bulky disease, anemia, thrombocytopenia, diffuse pattern of bone marrow infiltration and short tumor doubling time, were registered in a prospective therapeutic GISL trial and addressed to a watch and wait program. After 41.3 months of median follow-up, the median progression free survival (PFS) was not reached and 73% of cases did not progress. When additional variables were considered, in order to improve the prognostic model, it was evident that LDH level and the number of extranodal sites were of statistical significance in the multivariate analysis. Based on this finding, a prognostic score was devised which was able to further identify a small group of patients more likely to undergo early progression, and thus suitable for immediate treatment. In conclusion, the GISL definition of indolent disease is a reliable tool to design the appropriate therapeutic strategy in this histological setting.
authors.affiliation: Centro Trapianti di Midollo Osseo, Dipartimento di Ematologia, Azienda Ospedaliera Bianchi-Melacrino-Morelli Via Melacrino, 89100 Reggio Calabria, Italy. f.morabito@diel.it
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
authors.forename: Luca
authors.initials: L
authors.lastname: Baldini
authors.forename: Caterina
authors.initials: C
authors.lastname: Stelitano
authors.forename: Stefano
authors.initials: S
authors.lastname: Luminari
authors.forename: Antonio
authors.initials: A
authors.lastname: Frassoldati
authors.forename: Francesco
authors.initials: F
authors.lastname: Merli
authors.forename: Mariangela
authors.initials: M
authors.lastname: Colombi
authors.forename: Roberto
authors.initials: R
authors.lastname: Sabbatini
authors.forename: Maura
authors.initials: M
authors.lastname: Brugiatelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019468:Disease Management; D018572:Disease-Free Survival; D006801:Humans; D016130:Immunophenotyping; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D007770:L-Lactate Dehydrogenase