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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Available from: Jorge J Castillo, Dec 23, 2015
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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: 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.
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    ABSTRACT: Objective: To explore the clinical features and treatments of mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: The clinical data of 80 MALT lymphoma patients treated from September 2000 to November 2012 were retrospectively analyzed. Results: Among them, 32 (40.0%) had gastric MALT lymphoma and 48(60.0%) non-gastric MALT lymphoma. Gastric lymphoma associated anemia accounted for 50.0% (16/32) (25.0% (12/48) in non-gastric group, P = 0.022). In non-gastric group, stage III-IV diseases accounted for 35.4% (17/48) (12.5% (4/32) in gastric group, P = 0.022). During a median follow-up of 30 months, the 5-year overall survival (OS) rate was 90.0% and 5-year progression-free survival (PFS) rate 67.0%. For the non-gastric group, surgery plus chemotherapy group was superior in PFS to surgery alone group (the 3-year PFS rate 83.0% and 33.0%; median PFS 43.4 months and 20.3 months) (P = 0.040). Five-year OS in patients on first-line rituximab and chemotherapy without rituximab were 100.0% and 86.0% respectively (P = 0.106). Short-term response (OR = 0.258, P = 0.020) and low albumin (OR = 3.967, P = 0.009) were independent factor for PFS. Conclusions: Non-gastric MALT lymphoma is easily disseminated. Systemic treatment may be considered for advanced non-gastric MALT lymphoma. Surgery often leaves residual lesions for gastric MALT lymphoma.
    No preview · Article · Mar 2014 · Zhonghua yi xue za zhi
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