Second HSCT represents an effective therapeutic option for AL patients relapsed after allogeneic HSCT, with a 3-year LFS rate of 52% for the subset of patients who experienced relapse more than 292 days after receiving the first HSCT and who were in remission before receiving the second HSCT.

Both treatments were active; the better response rate and EFS obtained with the addition of rituximab did not translate into improved OS.

Our experience seems to confirm the clinical activity of rituximab in gastric MALT NHL patients resistant/refractory to antibiotics treatment or not presenting with clinical evidence of Helicobacter pylori infection. The t(11; 18)(q21; q21) translocation seems not to be a predictive marker to response or to subsequent relapse.

There are no widely accepted prognostic indices for extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). This study aimed to develop and validate a specific prognostic tool to personalize and optimize lymphoma 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 IELSG-19 trial (NCT 00210353). A validation set, including 633 patients, was obtained by merging three independent cohorts of MALT lymphoma patients. The three individual features maintaining the greatest prognostic significance for event-free survival (EFS, the main endpoint of the IELSG-19 trial) were age ≥70 years (HR 1.72, 95% CI 1.26-2.33), Ann Arbor stage III or IV (HR 1.79, 95% CI 1.35-2.38), and elevated LDH level (HR 1.87, 95% CI 1.27-2.77). The prognostic index (MALT-IPI) constructed using these three parameters identified three 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-IPI also significantly discriminated between patients with different progression-free, overall and cause-specific survival. The prognostic utility was retained in gastric and non-gastric lymphomas, in each treatment arm (chlorambucil, rituximab, 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