Comparative outcomes of oncologic therapy in gastric extranodal marginal zone (MALT) lymphoma: analysis of the SEER-Medicare database
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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ABSTRACT: Primary pulmonary MALT lymphoma is a rare disease, and no standard treatments have been defined yet. In this study, 38 consecutive patients from single center were reviewed. Among 25 patients with localized disease, radical surgery were performed in 12 patients, and the other 13 patients had chemotherapy combined with (7 patients) or without (6 patients) radiotherapy. No significant difference in overall survival (OS) was found between patients who received surgery or not; however, patients treated with chemotherapy had superior progression-free survival (PFS) than those treated with upfront surgery (P = 0.032). Among the 12 patients who received radical surgery, 7 were given adjuvant chemotherapy and 1 patient had consolidation radiotherapy. No significant differences in PFS and OS exist between those who received adjuvant treatment or not (P > 0.05). For patients who received chemotherapy, PFS and OS were significantly better for those treated with cyclophosphamide-based therapy than fludarabine-based therapy. At a median follow-up time of 61.1 months, 5- and 10-year PFS rate was 70.0 and 43.0 %, respectively, and 5- and 10-year OS rate was both 81.0 %. In conclusion, we confirmed the indolent behavior and favorable outcome of this disease. In order to preserve lung function and reduce the risks associated with surgery, radiotherapy or rituximab in combination with alkylating drug-based chemotherapy should be considered as first-line option for pulmonary MALT lymphoma.Tumor Biology 03/2015; DOI:10.1007/s13277-015-3329-y · 2.84 Impact Factor
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ABSTRACT: Introduction: Gastric mucosa associated lymphoid tissue (MALT) lymphoma, is an indolent cancer that occurs in the presence of pre-existing prolonged lymphoid proliferation in mucosal sites. In that instance, the most well established trigger is the gastric Helicobacter pylori (Hp) infection. Aim: Evaluation of clinical and laboratorial factors and the effect of therapy in achieving Complete Remission (CR) in patients with gastric MALT lymphoma. Methods: Multi-centric study from a geographic area (Southern Portugal), in which clinical and pathological features of patients with gastric MALT lymphoma, according to Dawson criteria for primary gastrointestinal lymphoma, were evaluated retrospectively with a follow-up ≥ 12 months. Lugano system was used for staging. Statistical analysis was performed using Kaplan-Meyer curves and bivariate analysis with Mann-Whitney test. A p-value of ≤ 0.05 was considered statistically significant. Results: A total of 34 cases were identified, 23 men, and 11 women, with an average age of 59 years. The most common symptom was epigastric pain (74%); 6 patients presented gastrointestinal bleeding and 3 patients had type B symptoms. The most prevalent localization was gastric body; 18 patients had an ulcerative pattern at endoscopy. At diagnosis, 91% and 94% were classified as limited disease (Lugano I-II and Ann Arbor IE-IIE respectively) and 94% had an International Prognostic Index (IPI)<3. A total of 20 patients (59%) had histological evidence of Hp infection. CR rate at one year was 77% (70% in the Hp-positive group versus 86% in the Hp-negative group), with an average remission time of 6 months. Using Lugano Staging System, CR was achieved in77% of patients with limited disease versus 67% in those with advanced disease. In the Hp-positive group, isolated antibiotic the rapyled to a CR in 60% of the cases, including one patient with advanced disease. One patient of the Hp-negative group achieved CR with isolated antibiotic therapy. The variables Limited Disease, IPI score <3, age, histological evidence of Hp, serum LDH, albumin and β2-microglobulin levels, were not associated with one year rate of CR (p>0.05). Conclusion: The results confirm the good prognosis and the indolence of MALT lymphoma. The variables studied couldn’t predict CR in 1 year, but enhance the idea that patients with early stage Hp-negative MALT lymphoma and with advanced disease, might still benefit from antibiotic treatment.Gastroenterology and Hepatology 04/2015; 2(2).
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ABSTRACT: Indolent nonfollicular B-cell lymphoma (INFBCL) has been classified in the World Health Organization 2008 system among the mature B-cell neoplasms and includes nodal and extranodal marginal zone lymphoma (MZL), lymphoplasmacytic lymphoma (LPL), and small lymphocytic lymphoma (SLL). Recently, the array and sequencing technologies have provided new insights into their molecular pathogenesis; the molecular discoveries, however, have not yet translated into consistent changes in their management. Thus, the therapy for INFBCL remains challenging. To promote widespread adoption of appropriate clinical practice, the Italian Society of Hematology and affiliate societies (Italian Society of Experimental Hematology and Italian Group for Bone Marrow Transplantation) reviewed the evidence regarding the management of these lymphomas to produce evidence-based recommendations aimed at contributing to therapy optimization and standardization. We used the Grades of Recommendation, Assessment, Development, and Evaluation system, which is based on a sequential assessment of the quality of evidence, followed by an analysis of the benefit/risk balance and subsequent judgment about the strength of recommendations. For issues without consistent evidence, we used the consensus technique. We have provided separate recommendations for diagnostic and staging requirements, first-line therapy, and postinduction therapy for the most frequent INFBCLs (ie, LPL, SLL, and nodal, splenic, and gastric MZL).Clinical Lymphoma, Myeloma and Leukemia 07/2014; 15(2). DOI:10.1016/j.clml.2014.07.002 · 1.93 Impact Factor