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Comparative Study
. 2013;18(2):190-7.
doi: 10.1634/theoncologist.2012-0251. Epub 2013 Jan 23.

Treatment of splenic marginal zone lymphoma with rituximab monotherapy: progress report and comparison with splenectomy

Christina Kalpadakis  1 , Gerassimos A Pangalis, Maria K Angelopoulou, Sotirios Sachanas, Flora N Kontopidou, Xanthi Yiakoumis, Stella I Kokoris, Evagelia M Dimitriadou, Maria N Dimopoulou, Maria Moschogiannis, Penelope Korkolopoulou, Marie-Christine Kyrtsonis, Marina P Siakantaris, Theodora Papadaki, Panayiotis Tsaftaridis, Eleni Plata, Helen E Papadaki, Theodoros P Vassilakopoulos
Affiliations
Comparative Study

Treatment of splenic marginal zone lymphoma with rituximab monotherapy: progress report and comparison with splenectomy

Christina Kalpadakis et al. Oncologist. 2013.

Abstract

Background: Treatment of splenic marginal zone lymphoma (SMZL) patients is not standardized. Recent data suggest that rituximab is highly effective and could be considered as initial therapy.

Aim: To assess the efficacy of rituximab monotherapy in a large series of patients with SMZL and compare these results with splenectomy results.

Methods: The studied population included 85 patients. Fifty-eight received rituximab at a dose of 375 mg/m2 per week for 6 weeks as induction followed by maintenance at the same dose every 2 months for 1-2 years, whereas 27 patients were treated using splenectomy only.

Results: The overall response rate to rituximab 2 months after the end of induction was 95% (complete response [CR], 45%; unconfirmed CR, 26%; partial response, 24%). The median times to hematologic and clinical response were 2 weeks and 3 weeks, respectively. Forty-three of 55 patients already completed the maintenance phase: 28 sustained their initial response, 14 improved their response, and one progressed. Eighty-five percent of splenectomized patients responded, and two were treated with rituximab as consolidation after splenectomy and achieved a CR. The 5-year overall and progression-free survival (PFS) rates for rituximab-treated and splenectomized patients were 92% and 77% (p = .09) and 73% and 58% (p = .06), respectively. Furthermore, maintenance therapy with rituximab resulted in a longer duration of response (at 5 years, PFS was 84% for patients receiving maintenance and 36% for patients without maintenance, p <.0001).

Conclusions: Rituximab is a very effective and well-tolerated therapy and may be substituted for splenectomy as the first-line treatment of choice for patients with SMZL.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Progression-free survival (PFS) probability in rituximab-treated (red line) and splenectomized patients (blue line) after 5 years.
Figure 2.
Figure 2.
Progression-free survival (PFS) probability in rituximab-treated patients according to maintenance.
Figure 3.
Figure 3.
Overall survival (OS) probability in rituximab-treated (red line) and splenectomized (blue line) patients.
See this image and copyright information in PMC

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