Survival outcomes with and without splenectomy in splenic marginal zone lymphoma

Olszewski, Adam J.

doi:10.1002/ajh.23314

Cited by 16 publications

(10 citation statements)

References 28 publications

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“…This association was not observed in other histologies, like mantle cell and T-cell lymphomas, even though they are usually disseminated and treated with chemotherapy. We observed a 49% rate of splenectomy in SMZL, similar to a previous study from 1995 to 2009 (52%) [26]. Higher OS in our cohort (74% versus 68% in prior studies) may reflect advances in the management of SMZL, particularly rituximab [12,[27][28][29].…”

Section: Discussionsupporting

confidence: 86%

Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base

Fallah

Olszewski

2019

Hematology

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Objectives: To examine the use of splenectomy, chemotherapy, and subsequent overall survival (OS) in contemporary patients with splenic lymphomas. Methods: We analyzed records of 6450 patients with various splenic lymphomas recorded in the National Cancer Data Base (2004-2013). Survival was compared using Mantel-Byer test to account for guarantee-time bias, stratified by age, sex, comorbidities, and lymphoma stage. Results: Splenectomy rate was overall 58%, and varied from 49% in splenic marginal zone (SMZL) to 77% in follicular lymphoma (FL). It significantly decreased across all histologies over time (overall from 69% in 2004, to 44% in 2013). Thirty-day mortality after splenectomy was 4%. Chemotherapy use varied from 40% in FL to 76% in diffuse large B-cell lymphoma (DLBCL), but increased significantly only for SMZL and T-cell lymphomas over time. Overall, 57% of splenectomies were performed as diagnostic procedures, which was significantly less common in academic hospitals (p < 0.0001). Following a diagnostic splenectomy, chemotherapy was not administered to 29% of patients with DLBCL, 49% with mantle cell, and 42% with T-cell lymphomas. Median OS ranged from 12.4 years for FL to 1.0 year for Tcell lymphomas. We found no association between performance of splenectomy and OS across all histologies. Patients with DLBCL who did not receive chemotherapy after a diagnostic splenectomy had significantly worse OS (p = 0.001). The association between postsplenectomy chemotherapy and OS was not observed in FL or SMZL. Conclusion: many splenic lymphomas may be treated without surgery, but a high proportion of diagnostic splenectomies indicates an ongoing need for less invasive diagnostic modalities.

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Section: Discussionsupporting

confidence: 86%

Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base

Fallah

Olszewski

2019

Hematology

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“…15,66 No randomized trials have been conducted in SMZL and, as consequence, there is no consensus on how to treat newly diagnosed and relapsed patients. The therapeutic options for SMZL have a wide range and include splenectomy, 1,7,59,61,[68][69][70][71][72][73] chemotherapy, [74][75][76][77][78][79][80][81] and rituximab alone 70,82,83 or rituximab with chemotherapy. 70,[84][85][86][87] In addition, antiviral treatment should be considered in patients with SMZL and concurrent chronic infection with HCV-related hepatitis who do not need immediate conventional treatment against the lymphoma.…”

Section: Treatmentmentioning

confidence: 99%

Splenic marginal zone lymphoma: from genetics to management

Arcaini

Rossi

Paulli

2016

Blood

131

129

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Splenic marginal zone lymphoma (SMZL) is a rare B-cell malignancy involving the spleen, bone marrow, and frequently the blood. SMZL lymphomagenesis involves antigen and/or superantigen stimulation and molecular deregulation of genes (NOTCH2 and KLF2) involved in the physiological differentiation of spleen marginal zone B cells. Diagnosis requires either spleen histology or, alternatively, the documentation of a typical cell morphology and immunophenotype on blood cells coupled with the detection of intrasinusoidal infiltration by CD20+ cells in the bone marrow. Among B-cell tumors, deletion of 7q and NOTCH2 mutations are almost specific lesions of SMZL, thus representing promising diagnostic biomarkers of this lymphoma. Although the majority of SMZLs show an indolent course with a median survival of approximately 10 years, nearly 30% of patients experience a poor outcome. No randomized trials are reported for SMZL, and few prospective trials are available. A watch-and-wait approach is advisable for asymptomatic patients. Treatment options for symptomatic patients ranges from splenectomy to rituximab alone or combined with chemotherapy. In some geographic areas, a subset of patients with SMZL associates with hepatitis C virus infection, prompting virus eradication as an effective lymphoma treatment. It would be worthwhile to explore deregulated cellular programs of SMZL as therapeutic targets in the future; improved clinical and biological prognostication will be essential for identifying patients who may benefit from novel approaches.

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“…Updated follow-up in 2013 also confirmed the benefits of splenectomy [ 15 ]. In addition, splenectomy has palliative effects on abdominal discomfort and prolonged the length of time before remission [ 16 ]. However, the overall survival, risk of histological transformation, and risk of death did not change with splenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…However, the overall survival, risk of histological transformation, and risk of death did not change with splenectomy. Other studies, in fact suggest that there is no difference in outcomes with or without splenectomy [ 16 ]. Rituximab, an anti-CD20 monoclonal antibody, has efficacy and complication rates equivalent to splenectomy and is an option in patients where surgery is relatively contraindicated.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Splenic Marginal Zone B-Cell Lymphoma Mimicking Relapsing Polychondritis of the Ear

Huang

Mendes

Sheykholeslami

2014

Case Reports in Otolaryngology

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Relapsing polychondritis (RPC) is a poorly understood phenomenon associated with cartilaginous inflammation of the ear, nose, tracheobronchial tree, and peripheral joints. Many cases of RPC respond to anti-inflammatories and resolve with no further complications. However, RPC has also been linked to more insidious conditions such as malignancies, autoimmune disorders, vasculitis, or underlying infections. Given the spectrum of associated disorders, patients with RPC may need to be monitored for more insidious underlying conditions. In this case, we report a unique case of bilateral auricular inflammation and nasal inflammation mimicking RPC as the only presenting symptom of splenic marginal zone B-cell lymphoma and we survey related cases in the literature.

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Survival outcomes with and without splenectomy in splenic marginal zone lymphoma

Cited by 16 publications

References 28 publications

Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base

Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base

Splenic marginal zone lymphoma: from genetics to management

A Rare Case of Splenic Marginal Zone B-Cell Lymphoma Mimicking Relapsing Polychondritis of the Ear

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