Early progression as a predictor of survival in marginal zone lymphomas: an analysis from the FIL-NF10 study

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Abstract

Marginal zone lymphomas (MZLs) are indolent nonfollicular B-cell lymphomas (INFLs) and have heterogeneous clinical behavior. Recently, time to progression of disease at 24 months (POD24) was identified to stratify overall survival (OS) in follicular non-Hodgkin lymphoma and in INFL. Here, we examined the ability of POD24 to predict subsequent OS in a large, international cohort of MZL as part of the NF10 prospective international registry headed by Fondazione Italiana Linfomi (FIL). POD24 was only calculated for MZL patients requiring immediate therapy and was defined as experiencing lymphoma progression within 24 months from diagnosis. Among the 1325 patients enrolled in the NF10 study, we identified 321 patients with MZL for whom immediate therapy was planned right after lymphoma diagnosis. Overall, POD24 was confirmed in 59 patients (18%). Three-year OS for patients with POD24 was 53% with a hazard ratio of 19.5 (95% confidence interval, 8.4-45) compared with patients without POD24 (3-year OS, 95%). Association of POD24 with OS was confirmed for the subgroup of splenic and extranodal MZLs. Assessment of POD24 stratifies subsequent outcome in MZL and identifies a high-risk population. This trial was registered at www.clinicaltrials.gov as #NCT02904577.

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A MALT lymphoma prognostic index.

Peter Johnson, Emanuele Zucca, Catherine Thieblemont … (2017)

There are no widely accepted prognostic indices for extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). This study aimed to develop and validate a specific prognostic tool to personalize and optimize treatment of patients with MALT lymphoma. A prognostic index was built by Cox regression (stepwise selection) using data from 401 patients enrolled in the international randomized International Extranodal Lymphoma Study Group 19 (IELSG-19) trial (NCT 00210353). A validation set, including 633 patients, was obtained by merging 3 independent cohorts of MALT lymphoma patients. The 3 individual features maintaining the greatest prognostic significance for event-free survival (EFS, the main endpoint of the IELSG-19 trial) were age ≥70 years (hazard ratio [HR], 1.72; 95% confidence interval [CI], 1.26-2.33), Ann Arbor stage III or IV (HR, 1.79; 95% CI ,1.35-2.38), and an elevated lactate dehydrogenase level (HR, 1.87; 95% CI, 1.27-2.77). The prognostic index (MALT-IPI) constructed using these 3 parameters identified 3 groups: low, intermediate, and high risk (corresponding to the presence of 0, 1, or ≥2 of these factors, respectively). The 5-year EFS rates in the low-, intermediate-, and high-risk groups were 70%, 56%, and 29%, respectively. The MALT-lymphoma International Prognostic Index (MALT-IPI) also significantly discriminated between patients with different progression-free, overall, and cause-specific survival. The prognostic utility was retained in gastric and nongastric lymphomas, in each treatment arm (chlorambucil, rituximab, and rituximab plus chlorambucil), and was confirmed in the validation set. The new index, MALT-IPI, is a simple, accessible, and effective tool to identify MALT lymphoma patients at risk of poor outcomes. It may help define appropriate treatment approaches for individual patients.

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Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis

Carla Casulo, Jonathan W. Friedberg, Kwang Ahn … (2018)

Patients with follicular lymphoma (FL) experiencing early therapy failure (ETF) within two years of frontline chemoimmunotherapy have poor overall survival (OS). We analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the National LymphoCare Study (NLCS) to determine whether autologous hematopoietic cell transplant (autoHCT) can improve outcomes in this high-risk FL subgroup.ETF was defined as failure to achieve at least partial response after frontline chemoimmunotherapy or lymphoma progression within two years of frontline chemoimmunotherapy. We identified two groups: the non-autoHCT cohort (patients from the NLCS with ETF not undergoing autoHCT); and the autoHCT cohort (CIBMTR patients with ETF undergoing autoHCT). All patients received rituximab-based chemotherapy as frontline treatment. 174 non-autoHCT patients and 175 autoHCT patients were identified and analyzed. There was no difference in five year OS between the two groups (60% vs 67% respectively; p=0.16). A planned subgroup analysis showed that patients with ETF receiving autoHCT soon after treatment failure (≤1year of ETF; n=123) had higher five year OS than those without autoHCT (73% vs 60%, p=0.05). On multivariate analysis, early use of autoHCT was associated with significantly reduced mortality (HR=0.63, 95%CI:0.42–0.94, p=0.02). Patients with FL experiencing ETF after frontline chemoimmunotherapy lack optimal therapy. We demonstrate improved OS when receiving autoHCT within one year of treatment failure. Results from this unique collaboration between the NLCS and CIBMTR support consideration of early consolidation with autoHCT in select FL patients experiencing ETF.

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Histologic transformation in marginal zone lymphomas†.

A. Conconi, S Franceschetti, K Aprile von Hohenstaufen … (2015)

Histologic transformation (HT) is a poorly understood event in patients with marginal zone lymphoma (MZL). The aim of this study was to analyze incidence and risk factors for HT in a large series of MZL patients.

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Author and article information

Journal

Title: Blood

Publisher: American Society of Hematology

ISSN (Print): 0006-4971

ISSN (Electronic): 1528-0020

Publication date Created: September 05 2019

Publication date (Print): September 05 2019

Volume: 134

Issue: 10

Pages: 798-801

Affiliations

[1 ]Division of Hematology, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Reggio Emilia, Reggio Emilia, Italy;

[2 ]Surgical, Medical and Dental Department of Morphological Sciences related to the Transplant, Oncology and Regenerative Medicine Department, University of Modena and Reggio Emilia, Modena, Italy;

[3 ]Division of Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi–Azienda Socio-Sanitaria Territoriale Sette Laghi, University of Insubria, Varese, Italy;

[4 ]Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;

[5 ]PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy;

[6 ]Lymphoma Unit, Department of Onco-hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy;

[7 ]Fondazione Italiana Linfomi, Modena, Italy;

[8 ]Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Turin, Turin, Italy;

[9 ]Division of Hematology 1, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza di Torino, Turin, Italy;

[10 ]Department of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy;

[11 ]Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy;

[12 ]Division of Hematology, Azienda Ospedaliero–Universitaria di Parma, Parma, Italy;

[13 ]Section of Hematology, Department of Medicine, University of Verona, Verona, Italy;

[14 ]Center of Hematology and Hemotherapy, Department of Internal Medicine, Faculty of Medicine, State University of Campinas, Campinas, Brazil;

[15 ]Division of Hematology, Department of Oncology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy;

[16 ]Division of Medical Oncology A, National Cancer Institute, Aviano, Italy;

[17 ]Department of Hematology, Azienda Ospedaliera Papardo, Messina, Italy;

[18 ]Unit of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy, University Campus Bio-Medico, Rome, Italy;

[19 ]Department of Cellular Biotechnology and Hematology, University La Sapienza, Rome, Italy;

[20 ]Division of Hematology 2, AOU Città della Salute e della Scienza di Torino, Turin, Italy; and

[21 ]Department of Molecular Medicine, University of Pavia, Pavia, Italy

Article

DOI: 10.1182/blood.2019001088

PubMed ID: 31292118

SO-VID: c3a60a92-bfc0-4bd6-a403-dae793120961

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Early progression as a predictor of survival in marginal zone lymphomas: an analysis from the FIL-NF10 study

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Most cited references 10

A MALT lymphoma prognostic index.

Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis

Histologic transformation in marginal zone lymphomas†.

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