Kalpadakis C, Pangalis G A, Dimopoulou M N, Vassilakopoulos T P, Kyrtsonis M-C, Korkolopoulou P, Kontopidou F N, Siakantaris M P, Dimitriadou E M, Kokoris S I, Tsaftaridis P, Plata E, Angelopoulou M K
First Department of Internal Medicine, National Kapodistrian University of Athens, Laikon University Hospital, Athens, Greece.
Hematol Oncol. 2007 Sep;25(3):127-31. doi: 10.1002/hon.820.
Splenectomy has traditionally been considered as a standard first line treatment for splenic marginal zone lymphoma (SMZL) conferring a survival advantage over chemotherapy. However it carries significant complications, especially in elderly patients. The purpose of this retrospective study was to report our experience on the efficacy of Rituximab as first line treatment in 16 consecutive SMZL patients, diagnosed in our department. The diagnosis was established using standard criteria. Patients' median age was 57 years (range, 48-78). Prior to treatment initiation all patients had splenomegaly, nine had anemia, five lymphocytosis, five neutropenia and six thrombocytopenia. Rituximab was administered at a dose of 375 mg/m2/week for 6 consecutive weeks. The overall response rate was 100%. After treatment, all patients had a complete resolution of splenomegaly along with restoration of their blood counts. Eleven patients (69%) achieved a CR, three (19%) unconfirmed CR and two (12%) a PR. Among the complete responders seven patients had also a molecular remission. The median time to clinical response was 3 weeks (range, 2-6). Rituximab maintenance was given to 12 patients. Eleven of them had no evidence of disease progression after a median follow-up time of 28.5 months (range, 14-36), while two out of four patients who did not receive maintenance, relapsed 7 and 24 months after the completion of induction treatment. Median follow-up time for the entire series was 29.5 months (range, 15-81). No deaths were recorded during the follow-up period. Therapy was well tolerated. The present study demonstrates that rituximab is an effective treatment for SMZL and could be considered as a substitute or alternative to splenectomy.
传统上，脾切除术一直被视为脾边缘区淋巴瘤（SMZL）的标准一线治疗方法，与化疗相比具有生存优势。然而，它会带来严重的并发症，尤其是在老年患者中。这项回顾性研究的目的是报告我们对16例在本科室确诊的连续SMZL患者使用利妥昔单抗作为一线治疗的疗效经验。诊断采用标准标准。患者的中位年龄为57岁（范围48 - 78岁）。在开始治疗前，所有患者均有脾肿大，9例有贫血，5例有淋巴细胞增多，5例有中性粒细胞减少，6例有血小板减少。利妥昔单抗以375 mg/m²/周的剂量连续给药6周。总缓解率为100%。治疗后，所有患者的脾肿大均完全消退，血细胞计数恢复正常。11例患者（69%）达到完全缓解（CR），3例（19%）为未确认的CR，2例（12%）为部分缓解（PR）。在完全缓解者中，7例患者也有分子缓解。临床缓解的中位时间为3周（范围2 - 6周）。12例患者接受了利妥昔单抗维持治疗。其中11例在中位随访时间28.5个月（范围14 - 36个月）后无疾病进展证据，而4例未接受维持治疗的患者中有2例在诱导治疗完成后7个月和24个月复发。整个系列的中位随访时间为29.5个月（范围15 - 81个月）。随访期间无死亡记录。治疗耐受性良好。本研究表明，利妥昔单抗是治疗SMZL的有效方法，可被视为脾切除术的替代或备选方案。
