Ariela Noy, MD:The decision to treat somebody with disseminated marginal zone lymphoma is similar to the decision to treat other indolent lymphomas. We have to keep in mind that these patients have long life expectancies. We do not want to overtreat patients, especially if the decision is made to treat them with drugs that have significant side effects. Even immunotherapy can cause side effects such as prolonged B-cell hypogammaglobulinemia, and this can leave a patient open to infection. When we add things like alkylating agents there is an added risk for a secondary malignancy such as acute myeloid leukemia or myeloproliferative neoplasia. As a result, we need to be judicious and have frank discussions with patients regarding if much their symptoms are bothering them and whether or not their case warrants therapy at this time.
We look at a number of different factors when we choose first-line therapy for patients with disseminated marginal zone lymphoma. One of the important things is the bulk of disease. The expectation is that patients with significantly bulky disease, which is a relatively rare occurrence, admittedly probably need more than immunotherapy, alone. The reason for that is you will more likely get a partial response with immunotherapy alone than with immunochemotherapy, which is associated with a high complete response rate. If you have a patient who has a high complete response rate, or one with a lot of tumor burden, single-agent rituximab will leave you with a relatively large disease burden if you only get a partial response.
Transcript edited for clarity.
A 64-Year-Old Woman With Advanced Extranodal MZL