Splenectomy with chemotherapy vs surgery alone as initial treatment for splenic marginal zone lymphoma.
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.
Milosevic
Rajko
R
Clinical Center of Serbia, 11 000 Belgrade, Serbia.
Todorovic
Milena
M
Balint
Bela
B
Jevtic
Miodrag
M
Krstic
Miodrag
M
Ristanovic
Elizabeta
E
Antonijevic
Nebojsa
N
Pavlovic
Mirjana
M
Perunicic
Maja
M
Petrovic
Milan
M
Mihaljevic
Biljana
B
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
D018951:Antigens, CD20; D000970:Antineoplastic Agents
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