Survival outcomes and prognostic factors in marginal zone lymphoma: A single-center experience from India.

Abstract

e19063 Background: Marginal Zone Lymphoma (MZL) is a rare subtype of Non-Hodgkin Lymphoma, accounting for only 5–12% of all B-cell lymphomas. There is limited data on real-world outcomes, especially in the low-middle income countries. We evaluated baseline characteristics, treatment patterns, and survival outcomes in patients with MZL treated at a tertiary care institute in India. Methods: Consecutive patients with confirmed diagnosis of MZL who presented at our centre between 2013-2022 were included. Medical records were reviewed and demographic and clinical data, including age, sex, performance status (ECOG PS), stage, presence of B symptoms, bulky disease, extranodal involvement, serum Hemoglobin (Hb) and Lactate dehydrogenase (LDH) levels at diagnosis, and treatment protocols, were retrieved. Progression-free survival (PFS) was defined as the interval from diagnosis to progression/relapse or death from any cause. Overall survival (OS) was defined from diagnosis to death from any cause. Survival curves were estimated by the Kaplan–Meier method. Potential prognostic factors were assessed using univariable and multivariable Cox proportional hazards models. Three-year and five-year survival rates were derived from Kaplan–Meier estimates. Results: Total 39 patients were included for analyses. The median age was 53 years (IQR: 43.5–63.5), with 21 (53.8%) males.28 (66.7%) had advanced stage (III/IV), 7 (17.9%) had ECOG PS ≥2, and 10 (25.6%) had B symptoms. Extranodal disease was observed in 25 (64.1%) patients, most commonly splenic (33.3%), followed by ocular (23.1%) involvement. Bulky lymph nodes (>10cm) were observed in 6 (16.2%) patients. Out of 76.9% of patients that received treatment, the majority received Bendamustine-Rituximab (BR) (41%) or Rituximab alone (23.1%). At a median follow-up of 44 months, the estimated 3-year and 5-year PFS rates were 84.5%±6.4% and 62.8%±10.6%, respectively. The estimated 3-year and 5-year OS rates of 87.6%±5.9% and 82.8%±7.3% respectively (Figure 1). On univariable Cox regression, ECOG PS 0-1 was significantly associated with superior PFS (HR=0.137, 95% CI=0.030-0.618, p < 0.01) and OS (HR=0.130, 95% CI=0.021-0.789, p < 0.05). Increasing age was also significantly associated with an elevated risk of progression (HR=1.06 95% CI=1.00–1.11, p<0.05). On multivariable analyses, ECOG 0-1 (adjusted HR=0.181, 95% CI=0.034-0.965, p<0.05) remained an independent predictor of better PFS. Advanced stage, presence of B symptoms, bulky lymph nodes, and extranodal involvement did not predict survival outcomes. Conclusions: In this real-world cohort, it was observed that MZL commonly presents with an advanced stage with a significant proportion requiring treatment, most commonly with BR. Good PS was predictive of superior outcome suggesting the importance of PS for risk stratification and treatment decision.