Validation of the Marginal Zone Lymphoma International Prognostic Index.

The Marginal Zone Lymphoma International Prognostic Index (MALT-IPI) was recently developed for use in patients with mucosa-associated lymphoid tissue (MALT) lymphoma based on age, serum lactate dehydrogenase level, and Ann Arbor stage. In this study, we aimed to validate the MALT-IPI. A total of 455 MALT lymphoma patients were included in this study from between January 2005 and February 2017. Event-free survival (EFS), progression-free survival (PFS), cause-specific survival (CSS), and overall survival (OS) were the primary outcomes. Of the 455 patients, MALT-IPI low-, intermediate-, and high-risk groups included 309 (67.9%), 126 (27.7%), and 20 (4.4%) individuals, respectively. When comparing the low-risk group (L MALT-IPI) with the intermediate-high-risk group (I-H MALT-IPI), EFS, PFS, CSS, and OS were significantly different (p = 0.000, p = 0.000, p = 0.027, and p = 0.037). The International Prognostic Index and the Follicular Lymphoma International Prognostic Index failed to predict the prognosis of MALT lymphoma. Use of the MALT-IPI significantly differentiated L MALT-IPI from I-H MALT-IPI with respect to EFS, PFS, CSS, and OS. MALT-IPI is a valuable tool for the prediction of MALT lymphoma prognosis.

How can we assess and measure prognosis for MALT lymphoma? A review of current findings and strategies.

INTRODUCTION: : MALT (mucosa associated lymphoid tissue) lymphoma is a distinct type of B-cell lymphoma characterized by extranodal manifestation and an indolent clinical course with 10-year survival rates up to 90%. However, transformation to aggressive lymphoma may occur and treatment is indicated in case of symptomatic or progressive disease. AREAS COVERED: : This review covers clinical and biological features potentially related to prognosis and outcome of MALT lymphoma patients, as well as available prognostic tools and risk stratification systems with a focus on the MALT-IPI (international prognostic index) and the POD24 (progression of disease at 24 months) cohort. In addition, we address the role of watch-and-wait, the importance of defining the optimal time point for treatment initiation and the relevance of depth of remission, which appear to be some of the central questions for physicians involved in the care of MALT lymphoma patients. A computerized database search using PubMed® was performed to identify available publications on prognostic factors and risk stratification tools in MALT lymphoma. EXPERT OPINION: : Despite the development of disease-specific risk stratification systems, there is no clear concept how to measure prognosis and tailor treatment. Careful observation of the individual clinical course is essential to assess the optimal time point of treatment initiation and avoid overtreatment, particularly in patients with disseminated disease. In addition, early detection of patients with histological transformation is necessary, as these patients face a poor prognosis.

Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue in the oromaxillofacial head and neck region: A retrospective analysis of 105 patients.

BACKGROUND: Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) in the oromaxillofacial head and neck region is rare, with limited data available. This retrospective study explored the clinical features, stage, treatment, and prognosis of this disease. METHODS: Overall, 105 patients with MALT lymphomas in the oromaxillofacial head and neck region were included in this retrospective analysis. SPSS 22.0 software package was used for data analysis and a two-tailed P value of ≤.05 was considered statistically significant. Primary endpoints of the study were the complete response (CR) rate, overall survival (OS), and progression-free survival (PFS). RESULTS: About 52% of the patients had long-term xerostomia, autoimmune diseases, or chronic parotitis and 81% had diseases involving the large salivary glands. Ann Arbor staging of the patients was as follows: stages I/II, 73 patients and stages III/IV, 32 patients. In the 97 patients followed up, CR rate after initial treatment was 80%. Tumor progression was observed in 12 patients and 14 patients died. There was a significant difference between the rate of CR in localized (87%) and disseminated (67%) lymphoma patients (P = .02). The 5- and 10-year PFS of the localized lymphoma patients were both 91%, whereas those of the disseminated lymphoma patients were 83% and 65%, respectively (P = .03). The 5-year PFS rates of the chemotherapy and non-chemotherapy groups in the disseminated lymphoma patients were 85% and 73% (P = .04). Meanwhile, the 5-year PFS rates of the rituximab and non-rituximab groups in the disseminated lymphoma patients were 100% and 70% (P = .03). In multivariate analysis, MALT Lymphoma International Prognostic Index (MALT-IPI) was an independent prognostic factor affecting OS, whereas Ann Arbor staging affected PFS. CONCLUSIONS: This study suggests that the outcome after initial treatment of MALT lymphomas in the oromaxillofacial head and neck region is satisfactory and that this disease progresses slowly. The CR rate and PFS of localized lymphoma patients are better than those of disseminated lymphoma patients. Systemic treatment (chemotherapy or rituximab) may improve PFS in disseminated disease patients. MALT-IPI and Ann Arbor staging are independent prognostic factors.