Retrospective evaluation of factors affecting treatment selection and survival in patients with nodal and splenic marginal zone lymphoma: A single-center experience

RETROSPECTIVE EVALUATION OF FACTORS AFFECTING TREATMENT SELECTION AND SURVIVAL IN PATIENTS WITH NODAL AND SPLENIC MARGINAL ZONE LYMPHOMA: A SINGLE-CENTER EXPERIENCE Objective: Marginal zone lymphoma (MZL) is the 3rd most common subtype of B cell non-Hodgkin's lymphoma and is divided into 3 groups as extranodal MZL (EMZL), nodal MZL (NMZL), and splenic MZL (SMZL). Due to the diversity of clinical manifestations and incomplete understanding of the disease biology, the optimal treatment approach and prognostic factors in MZL are not well defined. The aim of this study is to determine the factors affecting the development of relapsing or refractory disease, progression-free survival (PFS) and overall survival (OS) in patients with SMZL and NMZL. Materials and methods: Patients diagnosed with NMZL and SMZL between 2003 and 2023 were included in the study. Clinical and demographic characteristics, laboratory parameters, treatments, treatment responses and survival of the patients were evaluated retrospectively. Results: A total of 66 patients were included. Thirty-nine patients (59%) were female and 27 (41%) were male. The mean age at diagnosis was 59.26 ± 12.91 years (median 60, range: 27-84). Thirty-seven patients (56%) were diagnosed with SMZL and 29 (44%) with NMZL. The median follow-up duration was 67.5 months (range, 8-165) in the SMZL group and 46 (range, 7-153) months in the NMZL group. Mean OS was 146.14 ± 6.93 months. In SMZL patients, hemoglobin and LDH levels and the presence of B symptoms were shown to be associated with the development of relapsed or refractory disease. In NMZL patients, age at diagnosis, hemoglobin, serum creatinine, CRP, and beta 2 microglobulin levels, ECOG score, presence of B symptom and bone marrow involvement were found to be associated with the development of relapsed or refractory disease. With first-line treatment, the overall response rate (complete response + partial response) was 86.7% in the SMZL group and this was 81.3% in the NMZL group. The impact of treatment on PFS was analyzed. Among both SMZL and NMZL patients, there was no significant difference between watch and wait, surgical resection, and systemic treatment groups in terms of development of relapsed or refractory disease and PFS. Conclusions: Although many factors have been identified that might play a role in the development of relapsed or refractory disease in SMZL and NMZL, prospective randomized studies involving larger number of patients are needed to determine the optimal treatment approach in MZL. Key words: Marginal zone lymphoma (MZL), Chemotherapy, Splenectomy, Prognosis