Watch-and-wait or immediate immunotherapy/immunochemotherapy in patients with phase IE primary pulmonary MALT lymphoma? A multicenter retrospective study

Abstract

Primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is rare, and the optimal frontline treatment has not taken shape so far. It is still debatable whether the watch-and-wait (W&W) policy is beneficial to patients, especially in the early stage. This study was to compare the efficacy of W&W with rituximab single agent or combined chemotherapy (R/R-Chemo) on primary pulmonary MALT patients with localized disease. Clinical characters and effect on 28 patients with primary pulmonary MALT (IE phase) were analyzed. Among the 28 patients, 14 were grouped into W&W cohort, and 14 were immediately treated with R/R-Chemo. The median follow-up duration was 62 months. The estimated median time to treatment failure (TTF) in the W&W cohort and immediate R/R-Chemo cohort was 29 months and 59 months, which were not significantly different (P = 0.667). The estimated median time of overall survival (OS) in the W&W cohort and immediate R/R-Chemo cohort was 78 months and 76 months, which were also not statistically significant (P = 0.696). Concerning prognosis, there is no difference between patients with primary pulmonary MALT (IE phase) treated with W&W and with timely R/R-Chemo.

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Data availability

The data was identified by searching clinical databases from three institutions (Shengjing Hospital of China Medical University, The First Affiliated Hospital of China Medical University, and Cancer Hospital of China Medical University).

References

  1. 1.

    Kobayashi Y (2019) JSH practical guidelines for hematological malignancies, 2018: II. Lymphoma-2. Marginal zone lymphoma (MALT lymphoma/extranidal marginal zone lymphoma of mucosa-associated lymphoid tissue and splenic marginal zone lymphoma). Int J Hematol 110:393–405. https://doi.org/10.1007/s12185-019-02719-6

    Article  PubMed  Google Scholar 

  2. 2.

    Couto C, Martins V, Ribeiro V, Rodrigues C, Nogueira J, Oliveira A, Vieira JR (2019) Primary pulmonary MALT lymphoma: a case report and literature review. Biomed Hub 4:1–5. https://doi.org/10.1159/000502488

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Borie R, Wislez M, Antoine M et al (2016) Pulmonary mucosa-associated lymphoid tissue lymphoma revisited. Eur Respir J 48:1252–1255. https://doi.org/10.1159/000502488

    Article  PubMed  Google Scholar 

  4. 4.

    Sammassimo S, Pruneri G, Andreola G, Montoro J, Steffanoni S, Nowakowski GS, Gandini S, Negri M, Habermann TM, Raderer M, Li ZM, Zinzani PL, Adam P, Zucca E, Martinelli G (2016) A retrospective international study on primary extranodal marginal zone lymphoma of the lung (BALT lymphoma) on behalf of international extranodal lymphoma study group (IELSG). Hematol Oncol 34:177–183. https://doi.org/10.1002/hon.2243

    Article  PubMed  Google Scholar 

  5. 5.

    Oh SY, Kim WS, Kim JS, Kim SJ, Kwon HC, Lee DH, Won JH, Hwang IG, Kim MK, Lee SI, Chae YS, Yang DH, Lee GW, Choi CW, Park J, Suh C, Kim HJ (2010) Pulmonary marginal zone B-cell lymphoma of MALT type--what is a prognostic factor and which is the optimal treatment, operation, or chemotherapy?: consortium for improving survival of lymphoma (CISL) study. Ann Hematol 89:563–568. https://doi.org/10.1007/s00277-009-0875-7

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Wise LM, Arkfeld DG (2020) A patient with primary sjogren’s syndrome, cystic lung disease, and MALT lymphoma treated successfully with rituximab: a case-based review. Clin Rheumatol 39:1357–1362. https://doi.org/10.1007/s10067-019-04886-7

    Article  PubMed  Google Scholar 

  7. 7.

    Alvarez-Sánchez AI, MartÍnez-Losada C (2018) Rituximab monotherapy become an optimal treatment for primary pulmonary malt lymphoma. Leuk Res Rep 9:21–22. https://doi.org/10.1016/j.lrr.2018.02.004

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Swerdlow SH, Campo E, Harris NL et al (2008) Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). 4th ed. Lyon: International Agency for Research on Cancer (IARC)

  9. 9.

    Graham BB, Mathisen DJ, Mark EJ et al (2005) Primary pulmonary lymphoma. Ann Thorac Surg 80:1248–1253. https://doi.org/10.1016/j.athoracsur.2005.04.014

    Article  PubMed  Google Scholar 

  10. 10.

    Huang HH, Ko BS, Chen HM, Chen LJ, Wang CY, Hsiao FY (2020) Frontline treatments in extremely elderly patients with diffuse large B-cell lymphoma: a population-based study in Taiwan, 2010-2015. Immun Ageing 17:17. https://doi.org/10.1186/s12979-020-00188-8

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Kelemen K, Rimsza LM, Craig FE (2020) Primary pulmonary B-cell lymphoma. Semin Diagn Pathol S0740-2570:30036–30038. https://doi.org/10.1053/j.semdp.2020.04.002

    Article  Google Scholar 

  12. 12.

    Wang Y, Han J, Zhang F, Wang Z, Zhao D, Wang X, Wu N, Lu R, Wu C, Gao J, Pan L, Xue X (2019) Comparison of radiologic characteristics and pathological presentations of primary pulmonary lymphoma in 22 patients. J Int Med Res 27:300060519879854. https://doi.org/10.1177/0300060519879854

    CAS  Article  Google Scholar 

  13. 13.

    Wang L, Ye G, Liu Z, Shi L, Zhan C, Gu J, Luo R, Lin Z, Ge D, Wang Q (2019) Clinical characteristics, diagnosis, treatment, and prognostic factors of pulmonary mucosa-associated lymphoid tissue-derived lymphoma. Cancer Med 8:7660–7668. https://doi.org/10.1002/cam4.2683

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Wang B, Zhang C, Wang B, Zhang L (2015) Comparisons of surgery and/or chemotherapy in the treatment of primary pulmonary mucosa-associated lymphoid tissue lymphoma. Ann Thorac Cardiovasc Surg 21:109–113. https://doi.org/10.5761/atcs.oa.14-00145

    Article  PubMed  Google Scholar 

  15. 15.

    Girinsky T, Paumier A, Ferme C, Hanna C, Ribrag V, Leroy-Ladurie F, Ghalibafian M (2012) Low-dose radiation treatment in pulmonary mucosa-associated lymphoid tissue lymphoma: a plausible approach? A single-institution experience in 10 patients. Int J Radiat Oncol Biol Phys 83:e385–e389. https://doi.org/10.1016/j.ijrobp.2012.01.005

    Article  PubMed  Google Scholar 

  16. 16.

    Okamura I, Imai H, Mori K, Ogura K, Isoda A, Mihara K, Matsumoto M, Saito R, Takahashi T, Ikeda T (2015) Rituximab monotherapy as a first-line treatment for pulmonary mucosa-associated lymphoid tissue lymphoma. Int J Hematol 101:46–51. https://doi.org/10.1007/s12185-014-1694-8

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Ogusa E, Tomita N, Ishii Y, Takasaki H, Hattori Y, Matsumoto C, Ishigatsubo Y (2013) Clinical manifestations of primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in Japanese population. Hematol Oncol 31:18–21. https://doi.org/10.1002/hon.2008

    Article  PubMed  Google Scholar 

  18. 18.

    Du C, Zhang JQ, Wei Y et al (2018) Retrospective analysis of 9 cases of primary pulmonary mucosa-associated lymphoid tissue lymphoma and literature review. Med Sci Monit Basic Res 24:233–240. https://doi.org/10.12659/MSMBR.912762

    Article  PubMed  Google Scholar 

  19. 19.

    Seker M, Bilici A, Ustaalioglu BO, Salman T, Sonmez B, Canpolat NA, Salepci T, Gumus M, Yaylaci M (2009) Extended rituximab schedules may result in increased efficacy in pulmonary malt lymphoma. Leuk Res 33:e154–e156. https://doi.org/10.1016/j.leukres.2009.03.026

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Jhaveri K, Dimas DJ, Vakil A, Surani S (2019) Primary pulmonary involvement in mucosa-associated lymphoid tissue lymphoma. Cureus 11:e5110. https://doi.org/10.7759/cureus.5110

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Defrancesco I, Arcaini L (2018) Overview on the management of non-gastric MALT lymphomas. Best Pract Res Clin Haematol 31:57–64. https://doi.org/10.1016/j.beha.2017.11.001

    Article  PubMed  Google Scholar 

  22. 22.

    Torch M, Streubel B, Petkov V et al (2007) Does MALT lymphoma of the lung require immediate treatment? An analysis of 11 untreated cases with long-term follow-up. Anticancer Res 27:3633–3637. https://doi.org/10.1016/j.leukres.2009.03.026

    CAS  Article  Google Scholar 

  23. 23.

    Zhang MC, Zhou M, Song Q, Wang S, Shi Q, Wang L, Yan FH, Qu JM, Zhao WL (2019) Clinical features and outcomes of pulmonary lymphoma: a single center experience of 180 cases. Lung Cancer 132:39–44. https://doi.org/10.1016/j.lungcan.2019.04.004

    Article  PubMed  Google Scholar 

  24. 24.

    Lévy M, Copie-Bergman C, Amiot A, Dupuis J, Baleur YL, Belhadj K, Hémery F, Sobhani I, Delfau-Larue MH, Leroy K, Haioun C, Delchier JC (2013) Rituximab and chlorambucil versus rituximab alone in gastric mucosa-associated lymphoid tissue lymphoma according to t(11;18) status: a monocentric non-randomized observational study. Leuk Lymphoma 54:940–944. https://doi.org/10.3109/10428194.2012.729832

    CAS  Article  PubMed  Google Scholar 

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Acknowledgments

We would like to express our greatest gratitude to all the physicians and institutions involved in this study for their support. We would like to thank the pathology, thoracic surgery, and hematology departments of three institutions for providing us with the patient data. Thanks to the Natural Science Foundation of Liaoning Province for its support.

Funding

This study was funded by the Natural Science Foundation of Liaoning Province (201800875, 2018; 20180551257, 2018).

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Bin Wu, Ai-Jun Liao, and Wei Yang. The first draft of the manuscript was written by Wei Yan and Hui-Han Wang, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hui-Han Wang.

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The authors declare that they have no conflict of interest.

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This retrospective review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of China Medical University approved this study.

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Informed consent was obtained from all individual participants included in the study.

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Yan, W., Wu, B., Liao, AJ. et al. Watch-and-wait or immediate immunotherapy/immunochemotherapy in patients with phase IE primary pulmonary MALT lymphoma? A multicenter retrospective study. Ann Hematol 100, 709–714 (2021). https://doi.org/10.1007/s00277-021-04396-0

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Keywords

  • Watch-and-wait
  • Rituximab
  • Pulmonary MALT lymphoma
  • Prognosis