Division of Hematology and Oncology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Hematology, Otsu City Hospital, Otsu, Shiga, Japan.
Cancer Med. 2023 Feb;12(3):3134-3144. doi: 10.1002/cam4.5237. Epub 2022 Sep 12.
Primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML) is the most common subtype of indolent ocular adnexal lymphomas. Although radiotherapy (RT) is the standard of care for localized POAML, it can occasionally lead to permanent side effects. Other treatment strategies, such as rituximab (R) monotherapy and immunochemotherapy, have been used for POAML treatment, but their long-term benefits and relative merits remain unclear. While watchful waiting (WW) is a potential option for some indolent lymphomas, the benefits of WW for POAML patients are also unclear.
We here retrospectively analyzed 75 patients who were diagnosed with POAML between 2008 and 2019 in the institutions of the Kyoto Clinical Hematology Study Group.
Commonly involved sites were conjunctiva (42.7%), orbit (36.0%), and lacrimal gland (12.0%), and most patients (92.0%) presented with Ann Arbor stage IE disease. The treatment strategy was selected at the physicians' discretion. More patients without subjective symptoms by tumor mass were subjected to WW (29 patients), while more patients with tumor-derived subjective symptoms were treated by tumor-directed therapy (24 received focal RT, and 19 received R monotherapy). Complete response rates were 79.2% and 42.1% in the RT and R groups, respectively. At 60 months of follow-up, the estimated proportions of POAML patients not requiring new treatment were 69.4%, 85.2%, and 53.8% in the WW, RT, and R groups, respectively. There were no significant differences in the time to start a new treatment between WW and RT groups (median: both not reached [NR], p = 0.187) and between WW and R groups (median: NR vs. 69.0 months, p = 0.554). No specific predictive factor for the future need of treatment was identified in the WW group.
Our results demonstrate WW may be an acceptable treatment option for POAML, especially for asymptomatic patients.
原发性眼附属器黏膜相关淋巴组织（MALT）淋巴瘤（POAML）是惰性眼附属器淋巴瘤中最常见的亚型。虽然放疗（RT）是局限性 POAML 的标准治疗方法，但偶尔会导致永久性副作用。其他治疗策略，如利妥昔单抗（R）单药治疗和免疫化疗，已被用于 POAML 的治疗，但它们的长期获益和相对优点尚不清楚。虽然观察等待（WW）是一些惰性淋巴瘤的潜在选择，但 WW 对 POAML 患者的益处也不清楚。
我们回顾性分析了 2008 年至 2019 年期间京都临床血液学研究组机构诊断为 POAML 的 75 例患者。
常见受累部位为结膜（42.7%）、眼眶（36.0%）和泪腺（12.0%），大多数患者（92.0%）表现为安纳波利斯分期 IE 期疾病。治疗策略由医生决定。没有肿瘤肿块引起的主观症状的患者更多地接受 WW（29 例），而有肿瘤引起的主观症状的患者更多地接受肿瘤定向治疗（24 例接受局部 RT，19 例接受 R 单药治疗）。RT 组和 R 组的完全缓解率分别为 79.2%和 42.1%。在 60 个月的随访中，WW、RT 和 R 组中不需要新治疗的 POAML 患者的估计比例分别为 69.4%、85.2%和 53.8%。WW 组和 RT 组之间（中位：均未达到[NR]，p=0.187）以及 WW 组和 R 组之间（中位：NR 与 69.0 个月，p=0.554）开始新治疗的时间无显著差异。在 WW 组中，未确定未来需要治疗的特定预测因素。
我们的结果表明，WW 可能是 POAML 的一种可接受的治疗选择，特别是对于无症状患者。
