Splenic marginal zone lymphoma: a prognostic model for clinical use

Abstract

The Integruppo Italiano Linfomi (IIL) carried out a study to assess the outcomes of splenic marginal zone lymphoma and to identify prognostic factors in 309 patients. The 5-year cause-specific survival (CSS) rate was 76%. In univariate analysis, the parameters predictive of shorter CSS were hemoglobin levels below 12 g/dL (P < .001), albumin levels below 3.5 g/dL (P ‫؍‬ .001), International Prognostic Index (IPI) scores of 2 to 3 (P < .001), lactate dehydrogenase (LDH) levels above normal (P < .001), age older than 60 years (P ‫؍‬ .01), platelet counts below 100 000/ L (P ‫؍‬ .04), HbsAg-positivity (P ‫؍‬ .01), and no splenectomy at diagnosis (P ‫؍‬ .006). Values that maintained a negative influence on CSS in multivariate analysis were hemoglobin level less than 12 g/dL, LDH level greater than normal, and albumin level less than 3.5 g/dL. Using these 3 variables, we grouped patients into 3 prognostic categories: low-risk group (41%) with no adverse factors, intermediate-risk group (34%) with one adverse factor, and high-risk group (25%) with 2 or 3 adverse factors.

Splenic marginal zone lymphoma proposals for a revision of diagnostic, staging and therapeutic criteria

“…In the small proportion of patients with concomitant HCV infection, interferon-a 2b (IFN), ribavirin or a combination of both these agents has demonstrated a significant activity with clearance of HCV RNA in the blood; 8,77,78 therefore, these agents should be considered in the therapeutic scenario as a first line in this small cohort of patients. A minority of patients (ca.…”

Clinical and biological diversity of splenic marginal zone lymphoma

“…A study by the Italian group in 309 patients suggested three parameters predictive for a shorter cause-specific survival: hemoglobin less than 12 g/dl, elevated LDH and albumin less than 35 g/dl. These authors proposed a clinical prognostic model considering three categories: low risk (no adverse factors), intermediate risk (one adverse factor) and high risk (two or three adverse factors) [31]. However, it must be considered that the group of patients included was heterogeneous, there was a lack of comprehensive information on other biological parameters and that these patients were probably managed differently in the various centers with regard to initiation of treatment and use of therapeutic approaches shown to be effective in this lymphoma.…”

Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now

“…The Italian Society of Haematology, the Italian Society of Experimental Haematology, and the Italian Bone Marrow Transplantation Group have published guidelines for the management of both follicular and non-follicular i-NHL patients [4,5], suggesting WW as a valuable initial option especially in asymptomatic patients with FL stage II-IV and low tumour burden [4]. Similar to FL, asymptomatic patients with splenic MZL are commonly monitored without any treatment since WW does not compromise survival [6]; nevertheless, patients should be treated if they are symptomatic or have bulky disease or cytopenia [7]. Some MALT lymphoma patients can be monitored with WW as well, without significantly modifying survival rates [8].…”