Splenic marginal zone lymphoma: Prognostic factors, role of watch and wait policy, and other therapeutic approaches in the rituximab era

2016 ◽  
Vol 44 ◽  
pp. 53-60 ◽  
Author(s):  
Salvatore Perrone ◽  
Gianna Maria D’Elia ◽  
Giorgia Annechini ◽  
Antonietta Ferretti ◽  
Maria Elena Tosti ◽  
...  
Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3254-3254
Author(s):  
David Graham Oscier ◽  
Sarah J. Mould ◽  
Anne C. Gardiner ◽  
Sharron Glide ◽  
Anton E. Parker ◽  
...  

Abstract Splenic marginal zone lymphoma (SMZL) is generally an indolent disorder which has a median survival of 10 – 13 years, but a minority of patients pursue a more aggressive clinical course. A number of adverse prognostic factors including the level of haemoglobin, lymphocyte count and platelet count, B2 microglobulin, presence of a paraprotein, IgVH gene mutational status and p53 loss or mutation have been identified, but these have not been consistent among recent series. We have studied 89 patients with SMZL, diagnosed on the basis of lymphocyte morphology, immunophenotype and marrow and splenic histology, when available, and have evaluated the impact of presenting Hb, lymphocyte count, spleen size, presence of a paraprotein, cytogenetic abnormalities and IgVH gene mutational status on both the need for treatment and on overall survival. In 43 patients the diagnosis was made following a routine blood count performed for an incidental reason. The M:F ratio was 1:1.78, median age at presentation was 67.5 years (range; 49 – 91) and mean follow-up was 78.1 months. 63/89 (71%)patients presented with palpable splenomegaly, and a further 5 developed splenomegaly during the course of their disease. 42/89 (47%) patients required treatment of whom 29 (32%) underwent splenectomy. 36 patients have not required treatment, 25 have received an alkylating agent, 12 have received fludarabine and 4 were treated with rituximab.15/29 (17%) received chemotherapy for progressive disease post splenectomy. In six patients there was transformation to a high grade lymphoma. 14 patients (16%) died, 11 of whom had a disease-related death. 24/83 patients (29%) had a paraprotein, 67/87 (77%) had an abnormal karyotype of whom 39 (45%) had an abnormality of 7q. Using interphase FISH, 7/78((9%) showed trisomy 3 and 7/74(9%) had p53 loss. Of the patients with high grade transformation, 3/6 had p53 loss. 47/67 patients (70%) had mutated IgVH genes, and 15 cases utilised the VH1-02 gene segment. Only spleen size >10cm (p=0.0002) and Hb <100 gm/l (p=0.008) correlated with the need for treatment. Only unmutated IgVH genes (p=0.032) and the need for further therapy following initial treatment with splenectomy (p=0.034) correlated with overall survival.The median survival of unmutated cases was 113 months and was not reached for mutated cases.The median survival of patients for whom splenectomy has been their only treatment has not been reached, but was 110 months for patients requiring additional treatment post splenectomy. There is a need for larger, multi-centre studies to identify poor risk patients with SMZL.


2019 ◽  
Vol 30 ◽  
pp. v441
Author(s):  
G. Cengiz Seval ◽  
P. Topcuoglu ◽  
O. Arslan ◽  
G. Gurman ◽  
T. Demirer ◽  
...  

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8044-8044
Author(s):  
Adam J. Olszewski

8044 Background: The role of splenectomy as the primary therapy for splenic marginal zone lymphoma has been questioned. We studied relative survival in SMZL and the impact of splenectomy on lymphoma-specific survival (LSS). Methods: SMZL cases (diagnosed in 1993-2008) were derived from the SEER database. Age, sex and race-matched actuarial survival data were summarized. Factors predictive of splenectomy were studied using logistic regression with a subsequent propensity score (PS)-weighted survival analysis. Results: 1071 patients were identified with a median age of 69 years (range, 25-96) and a median follow up of 33 months. 53% were women and 92% were white. 70% of the lymphomas were stage III/IV with B symptoms recorded in 22.3%. 54% of patients underwent splenectomy. The significant factors predictive of surgery included younger age (p<10-14), stage I/II (p<10-15), B-symptoms (p=0.003), no prior malignancy (p=0.002), with significantly lower rates in black patients (OR 0.41, 95%CI 0.21-0.80, p=0.008), on the Pacific Coast (OR 0.62, 95%CI 0.47-0.81, p=0.0004) and with decreasing rates over time (p=0.0002). The actuarial 5-year relative survival was 82.8% (95%CI 77.9-86.7%) with no difference by sex (p=0.79), race or stage. 54% of deaths were related to SMZL with the estimated LSS of 80.8% (95%CI 78-84%). Splenectomy was not associated with improved LSS in propensity score-stratified log-rank test (p=0.60) or in the PS-weighted Cox model (HR=0.93, 95%CI 0.62-1.38, p=0.70). Advancing age (HR 1.05, 95%CI 1.03-1.07, p<10-8) and presence of B-symptoms (HR=1.98, 95%CI 1.30-3.01, p=0.002) were significantly predictive of death from SMZL, with no evidence of improvement in LSS over the years (HR=0.97, 95%CI=0.91-1.03, p=0.34). There was also no detectable impact of splenectomy on survival in patients who ultimately died of SMZL (p=0.83). Conclusions: In this cohort, the largest studied to date, splenectomy did not demonstrate a survival benefit in SMZL. Patients continue to have decreased survival despite advances in other indolent B-cell lymphomas. The role of splenectomy versus chemoimmunotherapy remains to be determined.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1125-1125
Author(s):  
C. Thieblemont ◽  
B. Ballester ◽  
V. Nasser ◽  
S. Gazzo ◽  
G. Doucet ◽  
...  

Abstract Splenic Marginal Zone Lymphoma (MZL) is described as an indolent lymphoma with a long term survival. However classical prognostic factors can not distinguish between patients who are likely to have good or poor outcomes. Moreover histological progression occurs in 10–20% of cases at the time of recurrence, but may be present at diagnosis, inducing a shorter survival with a median around 2 years. New model based on molecular understanding are needed to better discriminate these patients for their prognosis and disease evolution. Biopsy samples of splenic MZL from 43 patients treated in one institution and 8 with transformed splenic MZL were examined for gene expression using a nylon cDNA microarray consisting of 7, 000 human genes. Two of them came from a group of matched pair of splenic MZL and the transformed counterpart. An additional group comprising 4 transformed follicular lymphomas and 1 transformed small lymphocytic lymphoma were also analysed. Hierarchical clustering realized with all samples allowed to visualized patterns of gene expression already described in our previous work1 and corresponding to precise functions (proliferation, early response...), cell or tissue subtype (T cells, stroma …) or lymphoma subtype (MZL, MCL, SLL). The ability of individual genes to distinguish 1/ MZL and transformed-MZL subtypes, and 2/ alive patients and dead patients was calculated using a supervised method (discriminating score and bootstrap resampling). This allowed us to construct molecular predictors of survival and histological transformation. Transformation discriminating genes regrouped 73 genes related to cell proliferation such as CDC10, CDK4, PRKDC, PLCG2, LDHA, MCL2, and NPM1. P53 was down-expressed in all the transformed samples. Survival discriminating genes regrouped 26 genes from a unique cluster related to cell proliferation such as LDHA, NME1, MYC, ENO1. Although these genes seem to participate to the same function, only one gene was found discriminating the 2 parameters (LDHA). Gene ontology analysis using GOminer showed that the histological transformation was more related to cyclin-dependent protein kinase and that the survival was more related to metabolism. We used 26 genes to construct a predictor for survival in MZL patients. This gene-based predictor allowed predicting survival (p &lt;0.00001) in MZL patients better than with classical prognostic factors (age, performance status, stage, LDH, monoclonal component, IPI…), but also in transformed MZL patients. In conclusion, genes involved in histological transformation and survival in MZL patients are implicated in independent but complementary functions leading to cell proliferation.


Blood ◽  
2011 ◽  
Vol 118 (18) ◽  
pp. 4930-4934 ◽  
Author(s):  
Davide Rossi ◽  
Silvia Deaglio ◽  
David Dominguez-Sola ◽  
Silvia Rasi ◽  
Tiziana Vaisitti ◽  
...  

Abstract Splenic marginal zone lymphoma (SMZL) is one of the few B-cell lymphoma types that remain orphan of molecular lesions in cancer-related genes. Detection of active NF-κB signaling in 14 (58%) of 24 SMZLs prompted the investigation of NF-κB molecular alterations in 101 SMZLs. Mutations and copy number abnormalities of NF-κB genes occurred in 36 (36%) of 101 SMZLs and targeted both canonical (TNFAIP3 and IKBKB) and noncanonical (BIRC3, TRAF3, MAP3K14) NF-κB pathways. Most alterations were mutually exclusive, documenting the existence of multiple independent mechanisms affecting NF-κB in SMZL. BIRC3 inactivation in SMZL recurred because of somatic mutations that disrupted the same RING domain that in extranodal marginal zone lymphoma is removed by the t(11;18) translocation, which points to BIRC3 disruption as a common mechanism across marginal zone B-cell lymphomagenesis. Genetic lesions of NF-κB provide a molecular basis for the pathogenesis of more than 30% of SMZLs and offer a suitable target for NF-κB therapeutic approaches in this lymphoma.


2017 ◽  
Vol 17 ◽  
pp. S376
Author(s):  
Hunan Julhakyan ◽  
Aminat Magomedova ◽  
Sergey Kravchenko ◽  
Karen Danishyan ◽  
Eduard Gemdzian ◽  
...  

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1585-1585
Author(s):  
Paolo Marcatili ◽  
Silvia Zibellini ◽  
Sara Rattotti ◽  
Anna Chailyan ◽  
Marzia Varettoni ◽  
...  

Abstract Abstract 1585 Splenic marginal zone lymphoma (SMZL) is frequently associated with HCV infection and autoimmune disorders. Previous studies demonstrated a biased usage of immunoglobulin heavy variable genes (IGHV) and, in some cases, stereotyped B-cell receptors (BCRs). This characterization, however, is mainly based on the heavy chain alone, even if strong evidences are emerging on the role of light chain (Bikos et al. Leukemia 2012). The aim of this study was to analyze IG light variable genes (IGLV) of SMZL BCRs, VL-VH pairing and structural information and to investigate the sequence-structure-antigen (AG) relationship. To this end, we analyzed the VL-VH paired sequences of BCR from 52 SMZL pts (38 BM and 14 PB) diagnosed according to Matutes criteria (Leukemia, 2008). Sequences were analyzed using the IMGT/DBs and the IMGT/V-QUEST tool. The PIGS web server was used to build 3-D models of all antibodies (Abs). The Ab structures were compared using LGA and clustered together according to a score accounting for structure and sequence similarity. Using the DIGIT DB and tools, all the clusters were analyzed and compared to other IGs. Based on the IGHV nucleotide sequence identity to the germline, 7 sequences (13%) were considered ‘truly unmutated’ (100% sequence identity), 20 (39%) were ‘minimally or borderline mutated’ (97–99.9%) whereas 25 (48%) were ‘significantly mutated’ (<97%). IGHV families were used as follows: IGHV3 (58%), IGHV1 (27%) and IGHV4 (15%). The majority of pts carried kappa light chain (69%). The most frequently used IGKV families were IGKV3 (58%) and IGKV1 (28%), the most frequent IGLV family was IGLV1 (56%). Considering the VL-VH paired sequences, the two pairings IGHV3-23/IGKV3–20 (n=6) and IGHV1-02/IGLV1-47 (n=3) were significantly over-represented when compared to CLL and DIGIT DB sequences, indicating that the pairing between VL-VH chains was non-random. The IGHV1-02/IGLV1-47 paired sequences showed a high number of somatic mutations (>3%), whereas samples using the IGHV1-02 gene (n=10) but a VL gene other than from IGLV1-47 displayed a low number of mutations, suggesting a significant role for the light chain. In order to analyze the possible functional role of light chain, we analyzed the structural similarity of AG binding sites (ABSs), performing hierarchical clustering on the similarity obtained by an all-against-all structural superposition of each ABS. Twenty structural clusters were identified (8 with ≥3 samples) (Fig. 1). Considering IGs in the same major groups, they showed a similar mutation rate, pointing out a likely common AG selection at least in a fraction of pts (Fig. 1). In most cases, IGs in the same clusters display ABSs with similar physicochemical characteristics: positively charged binding sites (2 clusters), hydrophobic patches (3 clusters) or small pockets in the middle of the ABS (3 clusters) might be clue for different AGs specific for each cluster. HCV infection was found in 1 major and 2 minor clusters (Fig. 1), mainly associated with unmutated clones, indicating a likely common antigenic stimulation. In the other major clusters, the role for an AG-driven selection different from HCV in SMZL lymphomagenesis can be postulated. In particular, 3 clusters, containing both mutated and unmutated samples, displayed a statistically significant similarity to CLL clones (p<0.05), and 1 cluster was structurally similar to autoimmune clones (Kawasaki disease) (p=0.05). Of note, other clusters showed a degree of similarity with samples connected to diseases that involve an AG independent or superantigenic stimulation (EBV, Rabies virus, Rotavirus). In conclusion, the multi-layered characterization of the sequence and structure properties of paired VL-VH in SMZL identified a non-random pairing between heavy and light chains. Structural cluster analysis identified Abs with similar physicochemical properties, similar mutation rate and similar HCV status in a fraction of our dataset. Comparing Abs of our cases to a large dataset of human annotated Abs derived from the DIGIT DB, a subset resulted similar to CLL or autoimmune clones, whereas other Abs appeared more similar to polyreactive Abs and to Abs possibly targeted by superantigens. These findings could explain the large diversity observed in the IGs expressed in SMZL and provide new insights in SMZL pathogenesis. *The first two authors equally contributed to this paper Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2002 ◽  
Vol 100 (5) ◽  
pp. 1648-1654 ◽  
Author(s):  
Jose I. Chacón ◽  
Manuela Mollejo ◽  
Enriqueta Muñoz ◽  
Patricia Algara ◽  
Marisol Mateo ◽  
...  

A precise description of clinical features at presentation and analysis of clinical and biologic prognostic factors in splenic marginal zone lymphoma (SMZL) are still lacking. Here we describe the clinical and biologic features of a series of 60 SMZL patients diagnosed after splenectomy. Analysis for overall survival (OS), failure-free survival (FFS), and the probability of obtaining a response was performed using univariate and multivariate tests. The median age of the patient was 63 years (range, 35-84 years). Performance status according to the Eastern Cooperative Oncology Group (ECOG scale) was 0 = 16%, 1 = 58%, and 2 = 25%. Of the 60 patients, 53 (86.6%) were at Ann Arbor stage IV. All 60 patients received splenectomies, 29 of 60 also received chemotherapy, and 2 received spleen radiotherapy. A complete response (CR) was achieved by 38.3% of patients, and a partial response (PR) was achieved by 55%. Mean OS of the series was 103 months (range, 2-164 months); mean FFS was 40 months (range, 3-164 months). At 5 years from diagnosis, 39 patients (65%) were alive. Patients dying from the disease had a relatively aggressive clinical course, with a short survival (17.5 months [range, 2-72 months]). Significant prognostic factors in multivariate analysis were (1) (for OS and FFS) lack of response to therapy (CR versus noncomplete response [nCR]) and involvement of nonhematopoietic sites, and (2) (for the probability of obtaining CR) bone marrow involvement. Chemotherapy did not influence OS or FFS. p53 overexpression predicted a shorter OS in the univariate analysis. These data confirm the relative indolence of this disease, indicating the existence of a subset of more aggressive cases, which should stimulate the search for predictive biologic factors and alternative therapies.


Oncotarget ◽  
2018 ◽  
Vol 9 (52) ◽  
pp. 30005-30022 ◽  
Author(s):  
Jacob E. Robinson ◽  
Christine E. Cutucache

2006 ◽  
Vol 47 (1) ◽  
pp. 49-57 ◽  
Author(s):  
A. M. Florena ◽  
C. Tripodo ◽  
R. Porcasi ◽  
S. Ingrao ◽  
M. R. Fadda ◽  
...  

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