Rituximab With Or Without Chlorambucil For The Treatment Of Extranodal Marginal Zone B-Cell Lymphoma (MALT Lymphoma) Results From a Monocentric Study

Standard therapy of MALT lymphomas is not defined apart from H Pylori eradication for gastric localization.

This study was designed to evaluate the use of Rituximab (R) alone or in combination with Chlorambucil (RC) in the treatment of patients with diagnosis of MALT.

All patients with histologically confirmed diagnosis of MALT lymphoma were selected from our data base. Only patients treated with R or RC were analysed and evaluated. The scheme: rituximab 375 mg/sqm weekly for 4 doses, then monthly for 4 infusions alone or in combination with chlorambucil at the dosage of 0,1 mg/Kg/die for 45 days, then on days 1 to 15 monthly for 4 months.

From January 2000 to December 2012, 136 patients were diagnosed and treated in our Institution, 76 were selected because of uniformly treated with R or RC. The median age at diagnosis was 68 years (range 32-85). In 20 patients the disease was localized in conjunctiva; 17 in the stomach; 14 in the lung; 13 in salivary glands; 3 intestine; 2 respectively in lacrimal gland, liver, skin; 1 in breast, cheek and tongue. Stage was IA in 63 patients (83%), IB in 1, IIA in 5 patients and IIB in 1, IIIA in 1 patient, IVA in 4 patients and IVB in 1. Bone marrow biopsy was negative in 59 patients, positive in 5 and not performed in 12 patients. The proliferative index was evaluated in 50 patients with Mib1 monoclonal antibody: 42 patients showed less than 30% of positivity and 8 had more than 30% of positivity. The diagnosis of MALT in 4 patients was associated with Sjogren Syndrome, in 4 patients with a positive HCV and in 1 with scleroderma. According to treatment 61 patients were treated with the combination of Rituximab and Chlorambucil and 15 were treated with Rituximab alone. At the end of treatment 69 patients (91%) obtained a complete remission and 7 (9%) a partial remission with an overall response rate of 100%. With a median observation period of 54 months (range 1-160) the overall survival was 89%. Eight patients died 5 for progression of disease (2 after a relapse) and 3 for causes not related to the lymphoma. Ten patients (14%) relapsed, 8 of these patients were retreated with Rituximab and obtained a new complete remission.

After a long follow-up the combination of Rituximab and Chlorambucil or Rituximab alone proved to be low toxic, feasible and effective therapy for MALT lymphomas.

No relevant conflicts of interest to declare.