A MALT lymphoma prognostic index

Abstract

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

Short survival and frequent transformation in extranodal marginal zone lymphoma with multiple mucosal sites presentation

“…Most studies report an indolent natural course of EMZLs with prolonged survival . However, age ≥70 years, Ann Arbor stage III or IV and an elevated lactate dehydrogenase (LDH) level are associated with shorter progression‐free survival (PFS) and overall survival (OS) …”

Primitive Gastric Lymphoma - a Series of 3 Cases

“…MALT Primitive Gastric Lymphoma has a good prognosis when it is diagnosed before the age of 65, having a low degree of malignancy and the surgical resection respects oncological safety margins, with total tumor removal, as compared to those over 65 years old, when the prognosis is low and they are admitted in the performative stage of the tumor [12][13][14][15]. Survival rates to 5 years are over 90%, if the malignancy is low and over 60% if the degree of malignancy is high [16].…”

Prognostic role of baseline 18F‐FDG PET/CT parameters in MALT lymphoma

“…MALT lymphoma usually is lymphoma with optimal prognosis and a median survival beyond 10 years, but a part of them seems to be more aggressive and has a higher risk of relapse or transformation into aggressive NHL subtype, like diffuse large B‐cell lymphoma . In literature, many prognostic factors have been studied with conflicting results.…”

“…MALT lymphoma usually is lymphoma with optimal prognosis and a median survival beyond 10 years, but a part of them seems to be more aggressive and has a higher risk of relapse or transformation into aggressive NHL subtype, like diffuse large B-cell lymphoma. 8,13,26 In literature, many prognostic factors have been studied with conflicting results. Several factors were identified and associated with relapsefree survival, including disease age, presence of B symptoms, LDH level, performance status, and IPI score.…”