Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK.
Br J Haematol. 2012 Nov;159(3):322-8. doi: 10.1111/bjh.12036. Epub 2012 Sep 27.
Splenic marginal zone lymphoma (SMZL) is a rare B-cell malignancy, with no standard treatment other than splenectomy. Rituximab has shown encouraging results. We therefore retrospectively assessed 43 patients from two centres, who received rituximab, either alone or with chemotherapy. All patients responded, 34/43 (79%) achieving a complete response (CR), compared with 3/10 (30%) after chemotherapy without rituximab (P = 0·005). Of these 10 patients, 9 (90%) subsequently achieved a CR after rituximab (P = 0·02). Rituximab monotherapy appeared equally as effective as rituximab combination therapy (90% vs. 79% CR, P = 0·7) with significantly less toxicity (12·5% vs. 83%, P = 0·002). Splenectomized patients were more likely to obtain a CR with rituximab (16/16, 100%) than unsplenectomized patients (18/27, 67%, P = 0·008). Disease-free survival (DFS) at 3 years was better after rituximab than after splenectomy alone [79% (95% confidence interval 60-89) vs. 29% (8-54), Hazard ratio (HR) 0·28 (0·12-0·68), P = 0·003] and better than after chemotherapy without rituximab [25% (4-55), HR 0·21 (0·08-0·51), P = 0·0004]. Survival at 3 years after rituximab was 98%. In summary, the CR and DFS rates after rituximab, given alone or with chemotherapy, were significantly better than after chemotherapy without rituximab in the same patients, with manageable toxicity. Rituximab, with or without splenectomy, should be considered for the treatment of SMZL.
脾边缘区淋巴瘤（SMZL）是一种罕见的 B 细胞恶性肿瘤，除了脾切除术外，没有标准的治疗方法。利妥昔单抗已显示出令人鼓舞的结果。因此，我们回顾性评估了来自两个中心的 43 名患者，他们接受了利妥昔单抗单独治疗或联合化疗。所有患者均有反应，43 名患者中有 34 名（79%）达到完全缓解（CR），而未接受利妥昔单抗化疗的 10 名患者中仅 3 名（30%）达到 CR（P=0.005）。这 10 名患者中，有 9 名（90%）在接受利妥昔单抗治疗后均达到 CR（P=0.02）。利妥昔单抗单药治疗与利妥昔单抗联合化疗的疗效相当（90% vs. 79% CR，P=0.7），但毒性显著降低（12.5% vs. 83%，P=0.002）。脾切除患者接受利妥昔单抗治疗后更有可能获得 CR（16/16，100%），而非脾切除患者为 18/27（67%，P=0.008）。3 年时无疾病生存（DFS）率在利妥昔单抗组优于单独脾切除术组[79%（95%置信区间 60-89）vs. 29%（8-54），风险比（HR）0.28（0.12-0.68），P=0.003]，也优于未接受利妥昔单抗化疗组[25%（4-55），HR 0.21（0.08-0.51），P=0.0004]。3 年时利妥昔单抗组的生存率为 98%。综上所述，单独使用或联合化疗的利妥昔单抗治疗后的 CR 和 DFS 率明显优于同一患者未接受利妥昔单抗化疗的治疗，且毒性可管理。对于 SMZL 的治疗，应考虑使用利妥昔单抗联合或不联合脾切除术。
