Rituximab, used alone or in combination, is superior to other treatment modalities in splenic marginal zone lymphoma

• Published in: British journal of haematology Vol. 159; no. 3; pp. 322 - 328
• Main Authors: Else, Monica, Marín-Niebla, Ana, de la Cruz, Fátima, Batty, Paul, Ríos, Eduardo, Dearden, Claire E., Catovsky, Daniel, Matutes, Estella
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.11.2012; Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antibodies, Monoclonal, Murine-Derived - adverse effects; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; chemotherapy; Disease Progression; Female; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, B-Cell, Marginal Zone - drug therapy; Lymphoma, B-Cell, Marginal Zone - mortality; Male; Medical sciences; Middle Aged; Rituximab; splenectomy; splenic marginal zone lymphoma; Splenic Neoplasms - drug therapy; Splenic Neoplasms - mortality; toxicity; Treatment Outcome; Antineoplastic agent; Spleen; Drug combination; splenic marginal zone lymphoma; Hematology; Toxicity; Marginal zone lymphoma; Rituximab; Malignant hemopathy; Monoclonal antibody; Splenectomy; Chemotherapy; Chronic; Treatment; Surgery; Lymphoproliferative syndrome; Immunotherapy; Cancer
• ISSN: 0007-1048; 1365-2141; 1365-2141
• DOI: 10.1111/bjh.12036

Summary Splenic marginal zone lymphoma (SMZL) is a rare B‐cell malignancy, with no standard treatment other than splenectomy. Rituximab has shown encouraging results. We therefore retrospectively assessed 43 patients from two centres, who received rituximab, either alone or with chemotherapy. All patients responded, 34/43 (79%) achieving a complete response (CR), compared with 3/10 (30%) after chemotherapy without rituximab (P = 0·005). Of these 10 patients, 9 (90%) subsequently achieved a CR after rituximab (P = 0·02). Rituximab monotherapy appeared equally as effective as rituximab combination therapy (90% vs. 79% CR, P = 0·7) with significantly less toxicity (12·5% vs. 83%, P = 0·002). Splenectomized patients were more likely to obtain a CR with rituximab (16/16, 100%) than unsplenectomized patients (18/27, 67%, P = 0·008). Disease‐free survival (DFS) at 3 years was better after rituximab than after splenectomy alone [79% (95% confidence interval 60–89) vs. 29% (8–54), Hazard ratio (HR) 0·28 (0·12–0·68), P = 0·003] and better than after chemotherapy without rituximab [25% (4–55), HR 0·21 (0·08–0·51), P = 0·0004]. Survival at 3 years after rituximab was 98%. In summary, the CR and DFS rates after rituximab, given alone or with chemotherapy, were significantly better than after chemotherapy without rituximab in the same patients, with manageable toxicity. Rituximab, with or without splenectomy, should be considered for the treatment of SMZL.