San Diego, California—Results from a recent trial confirm the prognostic role of 2-year progressions-free survival (PFS) in patients with marginal zone lymphomas, and support the use of 2-year PFS in lieu of overall survival (OS) in clinical studies and management of these patients.

These findings were presented at the 2018 ASH Annual Meeting by lead investigator Stefano Luminari, MD, Hematology Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Italy.

“When therapy is needed in symptomatic patients, standard treatment usually requires systemic immunochemotherapy,” said Dr Luminari and colleagues.

“Although the outcome of MZL is generally measured in decades, a high heterogeneity of clinical behavior exists that warrants the identification of accurate prognostic features to better estimate the risk of relapse, progression or death in the individual patient,” they continued.

Recently, investigators examined whether PFS can be used to identify clinically useful end points in B-cell non-Hodgkin’s lymphomas (NHLs), and PFS at 2 years was found to stratify OS in follicular NHL.

Thus, Dr Luminari and colleagues decided to further this research and assess the use of PFS at 2 years to predict subsequent OS in patients with MZL. Using a large, international cohort of patients with indolent nonfollicular lymphoma, they gathered clinical, laboratory, treatment, and outcomes data of adults with MZL. These patients were followed-up with in accordance with local institution guidelines, and PFS was defined as time from diagnosis to disease progression, retreatment, or death from any cause.

Dr Luminari and colleagues only calculated 2-year PFS in patients who required immediate therapy and who were alive and with progression-free disease 24 months post-diagnosis. They defined subsequent OS as the time from achieving progression-free disease at 2 years or from disease progression in those whose MZL progressed within 24 months of their diagnosis.

According to the researchers, 1253 instances of indolent nonfollicular B-cell lymphoma were reported at 65 cancer centers across Europe and South America between July 2010 and July 2018. Of these cases, 677 (54%) were MZLs, including 283 (43%) patients with extra-nodal marginal zone lymphomas (ENMZL), 221 (32%) with splenic marginal zone lymphomas (SMZL), 104 (15%) with MZL classified as disseminated (Diss-MZL), and 69 (10%) with nodal marginal zone lymphomas. The median patient age was 66 years, and 6% of the patients had an Eastern Cooperative Oncology Group performance status >1.

Dr Luminari and colleagues identified 400 patients with MZL for whom immediate therapy was planned immediately after their lymphoma diagnosis; 59% of all patients with MZL required immediate therapy. Rituximab plus chemotherapy was used in 332 (82%)—142 (36%) received rituximab plus bendamustine, 101 (25%) received rituximab plus alkylating agents, and R plus CHOP in 50 (12%) received rituximab plus CHOP. A total of 36 (9%) patients were given rituximab as monotherapy.

The median follow-up was 38 months; among patients who received treatment for 3 years, 3-year PFS was 79% and 3-year OS was 90%. According to Dr Luminari and colleagues, progressive disease was the cause of death in 47% of all cases.

The percentage of patients who did not achieve PFS at 2 years was 20%, with a lower frequency in patients with NMZL and ENMZL (13%) versus SMZL and DissMZL (24%; P = .015). Among patients whose disease progressed within the first 2 years post-diagnosis, the 3-year OS was 46%, which, when compared with patients who did not have early relapse, yielded a hazard ratio of 28.3 

“The prognostic role of PFS is confirmed in both ENMZL and SMZL. Similarly to FL also in MZL, PFS24 should be considered as a surrogate for OS in clinical research and for patients management,” Dr Luminari and colleagues concluded.—Hina Khaliq

Luminari S, Marcheselli L, Defrancesco I, et al. Early Progression As a Predictor of Survival in Marginal Zone Lymphomas: An Analysis from the Prospective International NF10 Study By Fondazione Italiana Linfomi. Presented at: the 60th ASH Annual Meeting and Exposition; December 1-4, 2018; San Diego, CA. Abstract 393.