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A clinical analysis of two indolent lymphoma entities: mantle cell lymphoma
and marginal zone lymphoma (including the mucosa-associated lymphoid tissue
and monocytoid B-cell subcategories): a Southwest Oncology Group study
RI Fisher, S Dahlberg, BN Nathwani, PM Banks, TP Miller and TM Grogan
Loyola University Stritch School of Medicine, Maywood, IL.
The objectives of this study were (1) to determine the clinical
presentation and natural history associated with two newly recognized
pathologic entities termed mantle cell lymphoma (MCL) and marginal zone
lymphoma (MZL), including the mucosa-associated lymphoid tissue (MALT) and
monocytoid B-cell subcategories, and (2) to determine whether these
entities differ clinically from the other relatively indolent non-
Hodgkin's lymphomas with which they have been previously classified. We
reviewed the conventional pathology and clinical course of 376 patients who
had no prior therapy; had stage III/IV disease; were classified as Working
Formulation categories A, B, C, D, or E; and received cyclophosphamide,
doxorubicin, vincristine, prednisone (CHOP) on Southwest Oncology Group
(SWOG) studies no. 7204, 7426, or 7713. All slides were reviewed by the
three pathologists who reached a consensus diagnosis. Age, sex, performance
status, bone marrow and/or gastrointestinal involvement, failure-free
survival, and overall survival were compared among all the categories. We
found that (1) MCL and MZL each represent approximately 10% of stage III or
IV patients previously classified as Working Formulation categories A
through E and treated with CHOP on SWOG clinical trials; (2) the
failure-free survival and overall survival of patients with MZL is the same
as that of patients with Working Formulation categories A through E, but
the failure-free survival and overall survival of the monocytoid B-cell
patients were higher than that of the MALT lymphoma patients (P = .009 and
.007, respectively); and (3) the failure-free survival and overall survival
of patients with MCL is significantly worse than that of patients with
Working Formulation categories A through E (P = .0002 and .0001,
respectively). In conclusion, patients with advanced stage MALT lymphomas
may have a more aggressive course than previously recognized. Patients with
MCL do not have an indolent lymphoma and are candidates for innovative
therapy.
Volume 85,
Issue 4,
pp. 1075-1082,
02/15/1995
Copyright © 1995 by The American Society of Hematology
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