Splenic marginal zone lymphoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]
Overview
The predominant therapy for splenic marginal zone lymphoma is surgery. Adjunctive radiotherapy, chemotherapy, and biological therapy may be required. The optimal therapy for splenic marginal zone lymphoma depends on the clinical presentation.
Medical Therapy
- The optimal therapy for splenic marginal zone lymphoma depends on the clinical presentation.
- Treatment options for the condition are as under
Watchful waiting
- It is a slow growing tumor so patients may not need treatment right away unless symptomatic. Asymptomatic patients may be observed every 3-6 months.[1]
Immunotherapy
- In the pre-rituximab era splenectomy was considered to be the treatment of choice for splenic marginal zone lymphoma and still is performed for its treatment but rituximab is reported to be more beneficial in old age patients with co-morbid conditions.[2]
- Rituximab was reported to be a better option than splenectomy in terms of complete remission and overall survival of the patient.[3][4]
Chemotherapy
- chemotherapeutic drugs such as cyclophosphamide, clorambucil have been used in the past for the treatment of splenic marginal zone lymphoma but the results were not favourable.[5].
- Purine analogues such as fludarabine, pentostatin, have also been used. They are superior than alkylating agents in terms of efficacy but not better than rituximab and in addition to that they have their side efeects as well.[6]
Immunochemotherapy
- several chemotherapy regimens have been used in combination with rituxmab for the treatment of splenic marginal zone lymphoma showing high response rates and prolonged duration of response than chemotherapy alone.[7][2]
- But addition of chemotherapy doesn't seem to improve the efficacy of rituximab.[8]
| Therapy | Description |
|---|---|
| Watchful waiting | People may not need treatment right away unless they have symptoms |
| Splenectomy | Often respond very well when their spleen is removed with surgery |
| Radiation Therapy | When a splenectomy is not an option, external beam radiation therapy to the spleen |
| Chemotherapy | Doesn’t respond well to chemotherapy
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| Biological therapy | Rituximab may be used alone or in combination with chemotherapy |
References
- ↑ Matutes E, Oscier D, Montalban C, Berger F, Callet-Bauchu E, Dogan A, Felman P, Franco V, Iannitto E, Mollejo M, Papadaki T, Remstein ED, Salar A, Solé F, Stamatopoulos K, Thieblemont C, Traverse-Glehen A, Wotherspoon A, Coiffier B, Piris MA (March 2008). "Splenic marginal zone lymphoma proposals for a revision of diagnostic, staging and therapeutic criteria". Leukemia. 22 (3): 487–95. doi:10.1038/sj.leu.2405068. PMID 18094718.
- ↑ 2.0 2.1 Tsimberidou AM, Catovsky D, Schlette E, O'Brien S, Wierda WG, Kantarjian H, Garcia-Manero G, Wen S, Do KA, Lerner S, Keating MJ (July 2006). "Outcomes in patients with splenic marginal zone lymphoma and marginal zone lymphoma treated with rituximab with or without chemotherapy or chemotherapy alone". Cancer. 107 (1): 125–35. doi:10.1002/cncr.21931. PMID 16700034.
- ↑ Bennett M, Schechter GP (April 2010). "Treatment of splenic marginal zone lymphoma: splenectomy versus rituximab". Semin. Hematol. 47 (2): 143–7. doi:10.1053/j.seminhematol.2010.01.004. PMID 20350661.
- ↑ Kalpadakis C, Pangalis GA, Angelopoulou MK, Sachanas S, Kontopidou FN, Yiakoumis X, Kokoris SI, Dimitriadou EM, Dimopoulou MN, Moschogiannis M, Korkolopoulou P, Kyrtsonis MC, Siakantaris MP, Papadaki T, Tsaftaridis P, Plata E, Papadaki HE, Vassilakopoulos TP (2013). "Treatment of splenic marginal zone lymphoma with rituximab monotherapy: progress report and comparison with splenectomy". Oncologist. 18 (2): 190–7. doi:10.1634/theoncologist.2012-0251. PMC 3579603. PMID 23345547.
- ↑ Troussard X, Valensi F, Duchayne E, Garand R, Felman P, Tulliez M, Henry-Amar M, Bryon PA, Flandrin G (June 1996). "Splenic lymphoma with villous lymphocytes: clinical presentation, biology and prognostic factors in a series of 100 patients. Groupe Francais d'Hématologie Cellulaire (GFHC)". Br. J. Haematol. 93 (3): 731–6. PMID 8652403.
- ↑ Bolam S, Orchard J, Oscier D (October 1997). "Fludarabine is effective in the treatment of splenic lymphoma with villous lymphocytes". Br. J. Haematol. 99 (1): 158–61. PMID 9359516.
- ↑ Cervetti G, Galimberti S, Pelosini M, Ghio F, Cecconi N, Petrini M (September 2013). "Significant efficacy of 2-chlorodeoxyadenosine{+/-} rituximab in the treatment of splenic marginal zone lymphoma (SMZL): extended follow-up". Ann. Oncol. 24 (9): 2434–8. doi:10.1093/annonc/mdt181. PMID 23712547.
- ↑ Else M, Marín-Niebla A, de la Cruz F, Batty P, Ríos E, Dearden CE, Catovsky D, Matutes E (November 2012). "Rituximab, used alone or in combination, is superior to other treatment modalities in splenic marginal zone lymphoma". Br. J. Haematol. 159 (3): 322–8. doi:10.1111/bjh.12036. PMID 23016878.
- ↑ Splenic marginal zone lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/splenic-marginal-zone-lymphoma/?region=on Accessed on December 23,2015