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Ferrata Storti Foundation
Haematologica 2020 Volume 105(11):2592-2597
Non-Hodgkin Lymphoma
Early progression of disease predicts shorter survival in patients with mucosa-associated lymphoid tissue lymphoma receiving systemic treatment
Annarita Conconi,1 Catherine Thieblemont,2 Luciano Cascione,3 Valter Torri,4 Barbara Kiesewetter,5 Gloria Margiotta Casaluci,6 Gianluca Gaidano,6 Markus Raderer,5 Franco Cavalli,3 Armando Lopez Guillermo,7 Peter W. Johnson8 and Emanuele Zucca3,9 on behalf of the International Extranodal Lymphoma Study Group (IELSG)
1Division of Hematology, Ospedale degli Infermi, Biella, Italy; 2Hemato-Oncology Department, Saint Louis Hospital, Paris, France; 3Institute of Oncology Research, Bellinzona, Switzerland; 4Clinical Research Methodology Laboratory, IRCCS–Mario Negri Institute, Milan, Italy; 5Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria; 6Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; 7Department of Hematology, Hospital Clinic, Barcelona, Spain; 8Cancer Research UK Centre Southampton General Hospital, Southampton, UK and 9Division of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
Presented in part at the 2019 Annual Meeting of the American Society of Clinical Oncology (ASCO), held in Chicago, IL, USA, May 31 - June 4, 2019 and at the 15th International Conference on Malignant Lymphoma (15-ICML) held in Lugano, Switzerland, June 18-22, 2019.
ABSTRACT
Early progression of disease, within 2 years of diagnosis, is linked with poor overall survival in follicular lymphoma but its prognostic role in extranodal marginal zone B-cell lymphoma is less clear. We sought to identify prognostic factors associated with early progression of disease and to determine whether early progression is associated with inferior overall survival. We analyzed the impact of early progression of disease using the dataset of the International Extranodal Lymphoma Study Group-19 (IELSG-19) clinical trial (training set of 401 patients ran- domly assigned to chlorambucil or rituximab or chlorambucil plus ritux- imab). Reproducibility was examined in a validation set of 287 patients who received systemic treatment. We excluded from the analysis patients in both sets who, within 24 months of starting treatment, died without progression or were lost to follow-up without prior progression. Overall survival was calculated from progression in patients with early disease progression and from 24 months after the start of treatment in those whose disease did not progress early (reference group). Early dis- ease progression occurred in 69 of the 384 (18%) evaluable patients of the IELSG-19 study. Patients with a high-risk Mucosa-Associated Lymphoid Tissue - International Prognostic Index score were more likely to have early disease progression (P=0.006). The 10-year overall survival rate was 64% in the group with early disease progression and 85% in the reference group (hazard ratio = 2.42; 95% confidence interval: 1.35-4.34; log-rank P=0.002). This prognostic impact was confirmed in the valida- tion set, in which early progression was observed in 64 out of 224 (29%) evaluable patients with 10-year overall survival rates of 48% in the group with early disease progression and 71% in the reference group (hazard ratio = 2.15; 95% confidence interval: 1.19-3.90; log-rank P=0.009). In patients with extranodal marginal zone B-cell lymphoma who received front-line systemic treatment, early disease progression is associated with poorer survival and may represent a useful endpoint in future prospective clinical trials.
Correspondence:
ANNARITA CONCONI
annarita.conconi@aslbi.piemonte.it
Received: September 11, 2019 Accepted: January 2, 2020. Pre-published: January 2, 2020
doi:10.3324/haematol.2019.237990 ©2020 Ferrata Storti Foundation
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