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Early progression as a predictor of survival in marginal zone lymphomas: an analysis from the FIL-NF10 study

Stefano Luminari, Michele Merli, Sara Rattotti, Vittoria Tarantino, Luigi Marcheselli, Federica Cavallo, Marzia Varettoni, Benedetta Bianchi, Francesco Merli, Alessandra Tedeschi, Giuseppina Cabras, Francesca Re, Carlo Visco, Marcia Torresan Delamain, Emanuele Cencini, Michele Spina, Simone Ferrero, Angela Ferrari, Marina Deodato, Donato Mannina, Ombretta Annibali, Angela Rago, Lorella Orsucci, Irene Defrancesco, Marco Frigeni, Marina Cesaretti and Luca Arcaini

Key Points

  • Patients with MZL who experience POD24 from initial systemic therapy have a significantly increased risk of death.

  • Association of POD24 with survival is confirmed for the main MZL subtypes.

Publisher's Note: There is a Blood Commentary on this article in this issue.

Abstract

Marginal zone lymphomas (MZLs) are indolent nonfollicular B-cell lymphomas (INFLs) and have heterogeneous clinical behavior. Recently, time to progression of disease at 24 months (POD24) was identified to stratify overall survival (OS) in follicular non-Hodgkin lymphoma and in INFL. Here, we examined the ability of POD24 to predict subsequent OS in a large, international cohort of MZL as part of the NF10 prospective international registry headed by Fondazione Italiana Linfomi (FIL). POD24 was only calculated for MZL patients requiring immediate therapy and was defined as experiencing lymphoma progression within 24 months from diagnosis. Among the 1325 patients enrolled in the NF10 study, we identified 321 patients with MZL for whom immediate therapy was planned right after lymphoma diagnosis. Overall, POD24 was confirmed in 59 patients (18%). Three-year OS for patients with POD24 was 53% with a hazard ratio of 19.5 (95% confidence interval, 8.4-45) compared with patients without POD24 (3-year OS, 95%). Association of POD24 with OS was confirmed for the subgroup of splenic and extranodal MZLs. Assessment of POD24 stratifies subsequent outcome in MZL and identifies a high-risk population. This trial was registered at www.clinicaltrials.gov as #NCT02904577.

  • Submitted February 25, 2019.
  • Accepted June 25, 2019.
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