Early progression of disease predicts shorter survival in MALT lymphoma patients receiving systemic treatment

Abstract

Early progression of disease (POD) within two years from diagnosis is linked with poor overall survival (OS) in follicular lymphoma but its prognostic role is less clear in extranodal marginal zone B-cell lymphoma (EMZL). We sought to identify prognostic factors associated with early POD and to determine whether is associated with inferior OS. We analyzed the impact of early POD in the IELSG19 clinical trial dataset (training set of 401 patients randomly assigned to chlorambucil or rituximab or chlorambucil plus rituximab). Reproducibility was examined in a validation set of 287 patients who received systemic treatment. In both sets, we excluded from the analysis the patients who, within 24 months from treatment start, died without progression or were lost to follow-up without prior progression. OS was calculated from progression in patients with early POD and from 24 months after start of treatment in those without (reference group). Early POD was observed in 69 of the 384 (18%) evaluable patients of the IELSG19 study. Patients with high-risk MALT-IPI were more likely to have early POD (p=0.006). The 10-year OS rate was 64% in the early POD group and 85% in the reference group (HR= 2.42, 95%CI, 1.35-4.34; log-rank P=0.002). This prognostic impact was confirmed in the validation set, in which early POD was observed in 64 out of 224 (29%) evaluable patients with 10-year OS rate of 48% in the early POD group and 71% in the reference group (HR= 2.15, 95%CI, 1.19-3.90; log-rank P=0.009). In patients with EMZL who received front-line systemic treatment, early POD is associated with poorer survival and may represent a useful endpoint in future prospective clinical trials.

Figure 1.

Risk of disease progression. (A, B) Estimated hazard of progression for patients in the test set, formed of a cohort of individuals from the International Extranodal Lymphoma Study Group-19 (IELSG-19) study (A) and for the patients included in the validation set (B).

Figure 2.

Patients’ distribution. The selection and distribution of patients according to timing of disease progression in the test and validation sets. POD: progression of disease.

Figure 3.

Overall survival. (A, B) Kaplan-Meier estimates of overall survival and their confidence intervals according to the occurrence of early progression of disease in patients enrolled in the International Extranodal Lymphoma Study Group-19 randomized clinical trial (A) and in the validation set of patients who received frontline systemic therapy (B). POD: progression of disease.