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Outcomes of Patients with Splenic Marginal Zone Lymphoma Treated with Rituximab or Splenectomy: Report from Tertiary Cancer Center in India

In Clinical Lymphoma Myeloma and Leukemia
By: Bagal B.
Contributor(s): Mandal T | Bonda A | Punatar S | Gokarn A | Tembhare P | Jain H | Patkar N | Epari S | Sengar M | Khattry N | Shet T | Gujral S | Banavali S.
Material type: materialTypeLabelArticlePublisher: 2018Description: .Subject(s): Splenic marginal zone lymphoma | Splenectomy | Rituximab In: Clinical Lymphoma Myeloma and LeukemiaSummary: Context For Splenic marginal zone lymphoma (SMZL) splenectomy has been traditional initial therapy while single agent rituximab has emerged as an attractive option. There has been no prospective study comparing between these two treatments approaches. Design We reviewed medical records of all patients of SMZL at our hospital between January 2008 to December 2016. Baseline and treatment characteristics were collected and outcomes were analyzed. Progression free and overall survivals were calculated by Kaplan Meier methods and were compared log rank test. Results Total of 53 patients were treated during this period. Thirty-five patients (66%) were male and median age at diagnosis was 63 years (range 24 to 87 years). Median hemoglobin at presentation was 10 g/dL, total leukocyte count was 8.8 x 109 / L, platelets count was 102 x 109 / dL. As per the FIL prognostic score, 5 (9.4%), 9 (17 %) and 29 (54.7 %) were in low, intermediate and high-risk groups respectively. Thirty-eight patients were treated with Splenectomy, 10 received single agents rituximab while 5 were treated with bendamustine rituximab. Response assessment showed 41 patients achieved CR, PR in 6 patients, progressive disease in 1 patient and while response evaluation could not be done in remaining 5 patients. At median follow up period of 5.1 years, twelve patients have relapsed, 9 in Splenectomy and 3 in chemotherapy group. Nine patients have died, 7 in splenectomy group and 2 in chemotherapy group. The cause of death was progressive disease in 4 patients (2 each in group), 2 due to treatment toxicity (1 each post Splenectomy and after combination chemotherapy with BR, and 3 of unrelated causes (all in splenectomy group). The 5-year PFS and OS of whole cohort was 67% and 78% respectively. There was no difference in PFS and OS in groups who have undergone splenectomy versus rituximab with or without chemotherapy. Advanced age, lower baseline hemoglobin and high FIL score predicted poor OS. Conclusion Rituximab offers comparable outcomes to splenectomy in patients with SMZL.
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Articles Articles Tata Memorial Hospital
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Abstract published in Proceedings of the Society of Hematologic Oncology 2018 Annual Meeting

Context
For Splenic marginal zone lymphoma (SMZL) splenectomy has been traditional initial therapy while single agent rituximab has emerged as an attractive option. There has been no prospective study comparing between these two treatments approaches.

Design
We reviewed medical records of all patients of SMZL at our hospital between January 2008 to December 2016. Baseline and treatment characteristics were collected and outcomes were analyzed. Progression free and overall survivals were calculated by Kaplan Meier methods and were compared log rank test.

Results
Total of 53 patients were treated during this period. Thirty-five patients (66%) were male and median age at diagnosis was 63 years (range 24 to 87 years). Median hemoglobin at presentation was 10 g/dL, total leukocyte count was 8.8 x 109 / L, platelets count was 102 x 109 / dL. As per the FIL prognostic score, 5 (9.4%), 9 (17 %) and 29 (54.7 %) were in low, intermediate and high-risk groups respectively.

Thirty-eight patients were treated with Splenectomy, 10 received single agents rituximab while 5 were treated with bendamustine rituximab. Response assessment showed 41 patients achieved CR, PR in 6 patients, progressive disease in 1 patient and while response evaluation could not be done in remaining 5 patients. At median follow up period of 5.1 years, twelve patients have relapsed, 9 in Splenectomy and 3 in chemotherapy group. Nine patients have died, 7 in splenectomy group and 2 in chemotherapy group. The cause of death was progressive disease in 4 patients (2 each in group), 2 due to treatment toxicity (1 each post Splenectomy and after combination chemotherapy with BR, and 3 of unrelated causes (all in splenectomy group). The 5-year PFS and OS of whole cohort was 67% and 78% respectively.

There was no difference in PFS and OS in groups who have undergone splenectomy versus rituximab with or without chemotherapy. Advanced age, lower baseline hemoglobin and high FIL score predicted poor OS.

Conclusion
Rituximab offers comparable outcomes to splenectomy in patients with SMZL.

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