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Epperla N, Welkie RL, Torka P, Shouse G, Karmali R, Shea L, Anampa-Guzmán A, Oh TS, Reaves H, Tavakkoli M, Lindsey K, Greenwell IB, Hansinger E, Thomas C, Chowdhury SM, Annunzio K, Christian B, Barta SK, Geethakumari PR, Bartlett NL, Herrera AF, Grover NS, Olszewski AJ. Impact of early relapse within 24 months after first-line systemic therapy (POD24) on outcomes in patients with marginal zone lymphoma: A US multisite study. J Hematol Oncol 2023; 16:49. [PMID: 37158890 PMCID: PMC10165748 DOI: 10.1186/s13045-023-01448-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
Progression of disease within 24 months (POD24) from diagnosis in marginal zone lymphoma (MZL) was shown to portend poor outcomes in prior studies. However, many patients with MZL do not require immediate therapy, and the time from diagnosis-to-treatment interval can be highly variable with no universal criteria to initiate systemic therapy. Hence, we sought to evaluate the prognostic relevance of early relapse or progression within 24 months from systemic therapy initiation in a large US cohort. The primary objective was to evaluate the overall survival (OS) in the two groups. The secondary objective included the evaluation of factors predictive of POD24 and the assessment of cumulative incidence of histologic transformation (HT) in POD24 versus non-POD24 groups. The study included 524 patients with 143 (27%) in POD24 and 381 (73%) in non-POD24 groups. Patients with POD24 had inferior OS compared to those without POD24, regardless of the type of systemic therapy received (rituximab monotherapy or immunochemotherapy) at diagnosis. After adjusting for factors associated with inferior OS in the univariate Cox model, POD24 remained associated with significantly inferior OS (HR = 2.50, 95% CI = 1.53-4.09, p = 0.0003) in multivariable analysis. The presence of monoclonal protein at diagnosis and those who received first-line rituximab monotherapy had higher odds of POD24 on logistic regression analysis. Patients with POD24 had a significantly higher risk for HT compared to those without POD24. POD24 in MZL might be associated with adverse biology and could be used as an additional information point in clinical trials and investigated as a marker for worse prognosis.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA.
| | - Rina Li Welkie
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | | | | | | | - Lauren Shea
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Heather Reaves
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Kathryn Lindsey
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Irl Brian Greenwell
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Colin Thomas
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Sayan Mullick Chowdhury
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Kaitlin Annunzio
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Beth Christian
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | | | | | - Nancy L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Natalie S Grover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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