A new prognostic tool improves personalized treatment for patients with marginal zone lymphoma (MZL), according to recent research published in Blood (online July 2017; doi:10.1182/blood-2017-03-771915).
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Extranodal MZL of mucosa-associated lymphoid tissue (MALT lymphoma) is a rare subtype of non-Hodgkin lymphoma that often develops in the stomach. Currently, there is no widely accepted prognostic index for MALT lymphoma.
A group of multinational researchers led by Catherine Thieblemont, MD, PhD, Hematology-Oncology Department, Saint Louis Hospital (France), conducted a study aimed at developing and assessing a specific prognostic tool to personalize and optimize treatment for patients with MALT lymphoma. Researchers utilized Cox regression to build a prognostic index from data of 401 patients enrolled in an international randomized trial (IELSG-19; NCT 00210353). To validate the prognostic index, a cohort of 633 patients with MALT lymphoma were sampled by merging three independent cohorts.
Event-free survival was the main endpoint of the IELSG-19 trial. Researchers determined that the three individual factors contributing most to prognostic significance for event-free survival were age at least 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 lactate dehydrogenase level (HR, 1.87; 95% CI, 1.27-2.77). Using these three factors, the prognostic index was designed to identify three groups: low, intermediate, and high risk (corresponding to the presence of none, one, or at least two of these factors, respectively).
Five-year event-free survival rates in the low, intermediate, and high risk groups were estimated 70%, 56%, and 29%, respectively.
Additionally, the prognostic index was found to significantly discern between patients from the IELSG-19 trial with different progression-free survival, overall survival, and cause-specific survival. Prognostic accuracy was consistent across gastric and non-gastric lymphomas, in each treatment arm of the IELSG-19 trial (chlorambucil, rituximab, rituximab plus chlorambucil), and was confirmed in the validation cohort.
Researchers concluded that “the new index…is a simple, accessible and effective tool to identify MALT lymphoma patients at risk of poor outcomes.” Furthermore, the prognostic index for patients with MALT lymphoma may help define appropriate treatment approaches for individual patients, they wrote.—Zachary Bessette
