title: Splenic marginal zone lymphoma: Prognostic factors, role of watch and wait policy, and other therapeutic approaches in the rituximab era.
abstract: Splenic marginal zone lymphoma (SMZL) is an indolent lymphoma in which watch and wait (W&W) approach as well as splenectomy and chemo-immunotherapy are usually recommended. The role of the different approaches in relation to risk factors was evaluated. One hundred patients with SMZL were retrospectively studied. Median age was 65 years. HCV positivity was 3.1%. The 10-year overall-survival was 95.1% (CI: 90-100%). Sixty-two asymptomatic, low tumour burden patients were submitted to W&W. A low-risk group not requiring treatment was identified. Patients requiring treatment received splenectomy (36), chemotherapy-alone (27) and rituximab ± chemotherapy (16). In multivariate analysis, negative predictors for starting treatment were female-sex, splenomegaly, ECOG ≥ 1. Patients with low IIL-Score had a better 5-year TFT (24%). The median TFT of the W&W cohort was 58.5 months; at 10 years, 17% of patients were still on W&W. Splenectomy and rituximab ± chemotherapy showed similar results, while chemotherapy alone proved inferior. This real-life single-centre study of SMZL confirmed its very good prognosis with a survival likelihood overlapping that of general population. The prognostic role of IIL-Score was confirmed. The W&W approach allowed a median PFS longer than in follicular lymphoma. Finally, our data confirm the inferiority of chemotherapy compared to splenectomy and rituximab±chemotherapy.
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy. Electronic address: s.perrone@bce.uniroma1.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Perrone
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
authors.forename: Gianna Maria
authors.initials: GM
authors.lastname: D'Elia
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Annechini
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Ferretti
authors.affiliation: National Center for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Tosti
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
authors.forename: Robin
authors.initials: R
authors.lastname: Foà
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pulsoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D013156:Splenectomy / Q000401:mortality*; D013160:Splenic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Hepatitis C virus; NHL; Rituximab; Splenectomy; Splenic marginal zone lymphoma; Watch and wait