Comparative outcomes of oncologic therapy in gastric extranodal marginal zone (MALT) lymphoma: Analysis of the SEER-Medicare database

The Cancer Center at Memorial Hospital of Rhode Island, Pawtucket.
Annals of Oncology (Impact Factor: 7.04). 01/2013; DOI: 10.1093/annonc/mds644
Source: PubMed

Therapy for gastric marginal zone (MALT) lymphoma is largely based on single-arm trials. This observational study compared survival with radiotherapy, rituximab and combination chemoimmunotherapy in this disease.Patients and methodsGastric MALT lymphoma cases diagnosed between 1997 and 2007 were selected from the Surveillance, Epidemiology and End Results-Medicare database. Propensity score analysis and competing risk models were used to compare survival in patients with stage IE treated with radiation or chemotherapy, and in patients of all stages treated with rituximab alone or with chemoimmunotherapy.ResultsAmong 1134 patients, 21% underwent radiation and 24% chemotherapy as initial treatment. In the balanced cohort of 347 patients with stage IE, radiotherapy alone was associated with a better cause-specific survival [hazard ratio (HR) 0.27, P < 0.001]. Patients receiving systemic therapy had better survival if it incorporated rituximab (HR 0.53, P = 0.017). After adjustment for confounding, the outcomes of those who received rituximab alone or combination chemoimmunotherapy were not statistically different (P = 0.14).Conclusions
In elderly patients with stage IE gastric MALT lymphoma, radiotherapy was associated with lower risk of lymphoma-related death than chemotherapy. In those requiring systemic treatment, addition of cytotoxic chemotherapy to rituximab in the first-line regimen was not associated with improved survival.

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    • "We used claims from the 12-month period before treatment to construct correlates of the unavailable components of the International Prognostic Index (IPI)—lactate dehydrogenase levels and performance status. These included number of comorbid conditions (using the NCI modification of the Charlson Comorbidity Index), poor functional status indicator (based on utilization of home care, durable medical equipment and other medical services) and anemia (using claims for related medical services, blood transfusions and erythropoietin administration) [13] [17]. These variables strongly correlated with survival outcomes (Fig. S3 "
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    ABSTRACT: Using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database, we investigated the relative benefits of adding rituximab to CHOP chemotherapy in diffuse large B-cell lymphoma (DLBCL) of extranodal origin, and found similar advantage for nodal and extranodal lymphomas. Hazard ratio for overall survival was 0.64 for nodal, and 0.70 for extranodal DLBCL. Hazard ratios for lymphoma-related death were 0.62 and 0.57, respectively. The advantage was largest for DLBCL of the spleen, liver and lung. Conversely, it was not evident for thyroid or testicular lymphomas. Compared with nodal DLBCL, spleen was the only site with significantly better prognosis after R-CHOP.
    Leukemia research 05/2014; DOI:10.1016/j.leukres.2014.04.009 · 2.35 Impact Factor
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    ABSTRACT: Despite diagnostic and therapeutic advances, the majority of patients with splenic marginal zone lymphoma (SMZL) are still treated with splenectomy. We analyzed survival outcomes after surgery or rituximab-based systemic therapy in the Surveillance Epidemiology and End Results-Medicare database, using inverse probability of treatment weighting to minimize treatment selection bias. From the 657 recorded cases diagnosed between 2000 and 2007, with a median age of 77 years, we selected 227 eligible patients treated with splenectomy (68 %), rituximab alone (23 %), or in combination with chemotherapy (9 %) within 2 years from diagnosis. No significant difference between the groups was observed in the cumulative incidence of lymphoma-related death (LRD) at 3 years (19.6 % with systemic therapy and 17.3 % with splenectomy; hazard ratio [HR], 1.04; 95 % confidence interval [CI], 0.56-1.92; P = 0.90) or in the overall survival (HR, 1.01; 95 % CI, 0.66-1.55; P = 0.95). The 90-day mortality after splenectomy was 7.1 %. The rates of hospitalizations, infections, transfusions, and cardiovascular or thromboembolic events were higher after combination chemoimmunotherapy than after splenectomy. Conversely, there was no significant difference in most complications between groups treated with splenectomy or rituximab alone. The cumulative incidence of LRD after single-agent rituximab at 3 years was 18.7 % (95 % CI, 8.6-31.7). In conclusion, in SMZL patients over the age of 65 years, the risk of LRD and overall survival are similar with systemic therapy or splenectomy as initial therapy. Single-agent rituximab may offer the most favorable risk/benefit ratio in this population.
    Annals of Hematology 09/2013; 93(3). DOI:10.1007/s00277-013-1900-4 · 2.63 Impact Factor
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    ABSTRACT: AimThis study was undertaken to evaluate the clinical characteristics, prognostic factors, and long-term outcomes of patients with mucosa-associated lymphoid tissue (MALT) lymphoma in the gastrointestinal (GI) tract.Methods Clinical and pathological features of patients with MALT lymphoma in the GI tract, who were treated consecutively at Tianjin Medical University Cancer Institute and Hospital from 2001 to 2011, were evaluated retrospectively.ResultsAmong a total of 99 identified cases, 79.79% of lymphomas were localized in the stomach, 20.20% in the intestinal tract, and disseminated disease was detected in 35.4% of cases. The estimated five-year overall survival (OS) and five-year progression-free survival (PFS) rates were 73.1% and 65.1%, respectively. The comparison between stomach and intestinal tract lymphomas demonstrated no significant difference in characteristics, but nodal involvement was significantly lower in gastric MALT lymphoma (26.6%) as compared to intestinal tract MALT lymphoma (60%, p=0.006). The outcomes of gastric and intestinal MALT lymphomas were similar (OS, p=0.492; PFS, p=0.408), and so was the survival between proximal and distal gastric lymphomas (OS, p=0.077; PFS, p=0.181). Serum LDH level above normal was identified as the only adverse prognostic factor for both OS and PFS.Conclusion The clinical characteristics and outcomes demonstrated no significant differences between gastric and intestinal tract MALT lymphomas. Serum LDH level was an independent prognostic factor for the survival of GI MALT lymphoma.
    Journal of Gastroenterology and Hepatology 04/2014; 29(9). DOI:10.1111/jgh.12615 · 3.50 Impact Factor
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