title: Splenectomy with chemotherapy vs surgery alone as initial treatment for splenic marginal zone lymphoma.
abstract: OBJECTIVE
  To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS).
  
  
  METHODS
  A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined. Splenectomy plus chemotherapy was applied in 20 patients, while splenectomy as a single treatment-option was performed in 10 patients. Prognostic factor and overall survival rate were analyzed.
  
  
  RESULTS
  Complete remission (CR) was achieved in 20 (66.7%), partial remission (PR) in seven (23.3%), and lethal outcome due to disease progression occurred in three (10.0%) patients. Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank = 0.056, P > 0.05). Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions, as measured by computerized tomography and ultra-sound (t = 2.558, P = 0.018). Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank = 5.244, P < 0.05). The analysis of factors interfering with survival (by the Kaplan-Meier method) revealed that gender, general symptoms, clinical stage, and spleen infiltration type (nodular vs diffuse) had no significant (P > 0.05) effects on the OS. The expression of other antigens (immunohistochemistry) also had no effect on survival-rate, as measured by a c2 test (P > 0.05).
  
  
  CONCLUSIONS
  Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration; however, a larger controlled clinical study is required to confirm our findings.
authors.affiliation: Clinical Center of Serbia, 11 000 Belgrade, Serbia.
authors.forename: Rajko
authors.initials: R
authors.lastname: Milosevic
authors.forename: Milena
authors.initials: M
authors.lastname: Todorovic
authors.forename: Bela
authors.initials: B
authors.lastname: Balint
authors.forename: Miodrag
authors.initials: M
authors.lastname: Jevtic
authors.forename: Miodrag
authors.initials: M
authors.lastname: Krstic
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Ristanovic
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Antonijevic
authors.forename: Mirjana
authors.initials: M
authors.lastname: Pavlovic
authors.forename: Maja
authors.initials: M
authors.lastname: Perunicic
authors.forename: Milan
authors.initials: M
authors.lastname: Petrovic
authors.forename: Biljana
authors.initials: B
authors.lastname: Mihaljevic
mesh_terms: D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000096:biosynthesis; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D013156:Splenectomy / Q000379:methods*; D013160:Splenic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D018951:Antigens, CD20; D000970:Antineoplastic Agents
references.citation: Pathologe. 2008 Mar;29(2):143-7
references.pmid: 18214486
references.citation: Ann Oncol. 2009 Jan;20(1):129-36
references.pmid: 18718888
references.citation: Hematol Oncol. 2005 Sep-Dec;23(3-4):108-18
references.pmid: 16307458
references.citation: Blood. 2006 Jun 15;107(12):4643-9
references.pmid: 16493005
references.citation: Hematology Am Soc Hematol Educ Program. 2008;:359-64
references.pmid: 19074110
references.citation: Leuk Lymphoma. 2001 May;41(5-6):593-605
references.pmid: 11378577
references.citation: Am J Surg Pathol. 1996 Feb;20(2):211-23
references.pmid: 8554111
references.citation: Blood. 2003 Apr 1;101(7):2464-72
references.pmid: 12446449
references.citation: Cancer. 2004 Nov 1;101(9):2050-7
references.pmid: 15389479
references.citation: Ann Oncol. 1999 Dec;10(12):1419-32
references.pmid: 10643532
references.citation: Cytometry B Clin Cytom. 2008 Sep;74(5):282-6
references.pmid: 18500740
references.citation: Br J Haematol. 2008 Oct;143(1):71-4
references.pmid: 18671706
references.citation: Pathol Res Pract. 2008;204(1):23-6
references.pmid: 17913385
references.citation: Best Pract Res Clin Haematol. 2005 Mar;18(1):11-26
references.pmid: 15694182
references.citation: Clin Lab Haematol. 2004 Dec;26(6):397-401
references.pmid: 15595997
references.citation: Blood. 2002 Sep 1;100(5):1648-54
references.pmid: 12176884
references.citation: Blood Rev. 2005 Jan;19(1):39-51
references.pmid: 15572216
references.citation: Arch Surg. 2002 Jan;137(1):64-8
references.pmid: 11772218
references.citation: Clin Radiol. 1998 Feb;53(2):137-42
references.pmid: 9502091
references.citation: Hematology. 2008 Oct;13(5):276-81
references.pmid: 18854089
references.citation: Hematol Oncol Clin North Am. 2008 Oct;22(5):883-901, viii
references.pmid: 18954742
references.citation: Mod Pathol. 2009 Feb;22(2):206-15
references.pmid: 18820675
references.citation: Am J Clin Pathol. 2008 May;129(5):714-22
references.pmid: 18426730
references.citation: Haematologica. 2003 Jan;88(1):80-93
references.pmid: 12551831
references.citation: Leukemia. 2008 Aug;22(8):1621-4
references.pmid: 18305562
references.citation: Leuk Lymphoma. 2008;49 Suppl 1:35-42
references.pmid: 18821431
references.citation: J Exp Med. 2008 Jun 9;205(6):1317-29
references.pmid: 18490492
references.citation: Br J Haematol. 2003 Mar;120(5):759-64
references.pmid: 12614206
references.citation: Blood. 2005 Sep 1;106(5):1831-8
references.pmid: 15914563
references.citation: Ann Hematol. 2009 Apr;88(4):379-81
references.pmid: 18709501
references.citation: Histopathology. 2002 Feb;40(2):117-26
references.pmid: 11952855
references.citation: Pathologe. 2008 Mar;29(2):136-42
references.pmid: 18214484
references.citation: Lancet Oncol. 2003 Feb;4(2):95-103
references.pmid: 12573351