Novel Advancements in Marginal Zone Lymphoma Research

At the 2024 Lymphoma, Leukemia & Myeloma (LL&M) Congress in New York, New York, Peter Martin, MD, Weill Cornell Medicine, New York, New York, discusses novel data in the marginal zone lymphoma (MZL) treatment landscape, including new international prognostic indexes (IPIs) and the role of positron emission tomography–computed tomography (PET CT) scans to detect bone marrow involvement among patients.

Transcript:

Hi, I'm Peter Martin from Weill Cornell Medicine here in New York [and] I'm a lymphoma doctor. Today I gave a talk about what's new in marginal zone lymphoma. There were a few things that I think are interesting or worth highlighting.

One of them is the new entity of primary cutaneous marginal cell lymphoma. I think in the past we divided marginal cell lymphomas into extra nodal and splenic. Now there is a new entity of primary cutaneous marginal cell lymphoma, which is biologically distinct from other cutaneous lymphomas and biologically distinct from other marginal zone lymphomas. Other interesting pieces of data that I'd maybe like to bring up [were] a couple of things.

One, there was recently a publication from an Italian group looking at something called the Marginal Zone Lymphoma IPI. It is yet another international prognostic index, and in and of itself, maybe those international prognostic indices are not so exciting, except that I think what this one showed is that most people with marginal zone lymphoma fall into an intermediate or low-risk group, and only about 16% of people fall into a high-risk group.

So, if we're designing clinical trials for marginal zone lymphoma, including people with relatively low-risk marginal zone lymphoma, [it] probably isn't going to move the needle significantly in terms of impacting somebody's life and maybe focusing a little bit more intently on those higher-risk patients, particularly if we're reusing regimens that are a little bit more intensive or have more side effects. I think focusing on those patients who maybe have more to gain is probably worth more effort on our part.

Another interesting piece of data was from the Lymphoma Epidemiology of Outcomes (LEO) cohort study [that] looked at bone marrow involvement in marginal zone lymphoma and the role of PET CT scans. It turns out that PET CT scans probably do not do a very good job of picking up marginal zone lymphoma in the bone marrow of most [patients], at least those who have splenic marginal zone lymphoma and maybe nodal marginal cell lymphomas might do a little bit better with extra nodal marginal zone lymphoma. But part of that might be because it's rare that there's bone marrow involvement in those patients. So [unfortunately], PET scans don't do a great job of telling us whether there's bone marrow involvement.

However, when you look at the outcomes of patients with marginal zone lymphoma, we see that whether there's bone marrow involvement, generally the outcomes are similar. From my perspective, from a staging perspective, bone marrow biopsies play a little role even though PET scans don't really help us there. So maybe from a diagnostic perspective or if there's a specific question, but otherwise, I don't see a real role in bone marrow biopsies for marginal zone lymphoma.

I found a couple of papers that were analysis of larger data subsets, [where] one of them showed that moderate to vigorous exercise is associated with a lower risk of non-Hodgkin lymphomas and specifically marginal zone lymphomas [with] more vigorous exercise. I think if you're looking for a reason to exercise, marginal zone lymphoma prevention might not be it necessarily, there are probably other better reasons, but [it’s a] side benefit for sure.

However, if you are exercising vigorously with the intention of marginal zone lymphoma prevention, unfortunately, air pollution is also associated with an increased risk of marginal zone lymphoma. Maybe [that is] not entirely surprising given that marginal zone lymphoma is associated with chronic inflammation in general, and air pollution can be associated with chronic inflammation, particularly of the airways. In this study, they found [that] nitric dioxide and carbon monoxide [was] associated with an increased risk of marginal zone lymphomas as well as non-Hodgkin lymphomas.

Source:

Martin P. What’s New in Marginal Zone Lymphoma? Presented at Lymphoma, Leukemia & Myeloma Congress; October 16-19, 2024. New York, NY.