Marginal Zone Lymphoma

🗣️:🇺🇲/👥: 👨‍⚕️🩸🦀 🤔 Peripheral flow cytometry for a possibility of firstly hairy cell leukemia and than marginal zone lymphoma. Bone marrow Asp&biopsy for BRAF mutation, and further differantiate possible causes. If one of them watch & wait might be a rational solution. (@Dr_MSU)

@JudithTrotman1 @MinnemaMonique @c_thieblemont #KarimaAmaador @lymphomaOz #lymphoma #MZL #WM #WaldenströmsMacroglobulinemia (@WomenInLymphoma)

Very helpful 🙏 Because we use D-CyBorD so ubiquitously for AL amyloidosis, I sometimes think about R-bortezomib when the clone is unexpectedly shown to be MZL and not a plasma cell clone... but I will stick to R-Benda based on this! (@RahulBanerjeeMD)

Good Q. I don’t think we explicitly collected that data, we relied on investigators to assign cases as MZL based on their judgement and I assume at least some cases had MYD88 checked. @NEpperla any comments? (@PallawiTorkaMD)

Congrats @NEpperla @PallawiTorkaMD on great @BloodAdvances paper about +SPEP in MZL! Also relevant to us on other side of the aisle as #MMsm docs: rarely the culpable AL amyloid clone is paraprotein-producing MZL, and R-Benda >> R. (Authors: curious, did anyone get Velcade?) (@RahulBanerjeeMD)

Congrats on the interesting study! Im wondering if some of the emzl and nodal mzl patients may have been lpl/wm which are more commonly associated with an m protein. Would explain the lower response to single agent Rituximab (@Charanpreet_14)

#lymsm Ever wondered about the impact of M protein in your patients with MZL? Read our new paper spearheaded by @NEpperla @OSUCCC_James and @lymphomatic, out now in @BloodAdvances @ASH_hematology https://t.co/1E4FiEHHMh (@PallawiTorkaMD)

Rituximab and Ibrutinib in frontline MZL #lymsm showing a ORR 91% and 2 yr PFS 77% #17icml https://t.co/DmB1fnQdn7 (@HayderSaeed_MD)

7 yrs of FUP? Just because the study was planned too small in sample size and was ridden out until the very end because it was the important PMR for MZL indication. Even delayed public data reporting for a year to avoid having to give away their indication. Understandable, yes, (@Hieflo23)

SELENE RCT of ibrutinib vs placebo + RCHOP or BR in R/R FL or MZL #17ICML: - 403 pts randomized, vast majority FL, most got BR - no difference in PFS or OS (same for small MZL subgroup) - more high grade AEs in ibr arm Not surprising, but 7 yrs of f/u is great. #lymsm (@majorajay)

#ICML17 @StefanoLuminari @FIL presents new MZL IPI with 5 factors LDH ALC HbPlts and MZL subtype validated in external dataset @MayoClinic (@SFBarringtonKCL)

Excellent talk from @JuanAlderuccio showing correlation between FDG-avidity in extranodal MZL with tumor size, physiologic activity and location highlighting the need for PET/CT to improve patient care. @SylvesterCancer @icmlugano @Hemato_MDPI (@Skye_Montoya)

More data supporting immunotherapy (anti-CD20) alone as first-line treatment for MZL! Indeed, in splenic MZL chemoimmunotherapy associated worse outcome Less is more in most MZLs #17ICML (@Fer_martinmoro)

#17ICML|Adam Olszewski (@lymphomatic) presents real world analysis data showing similar OS between immunotherapy(Imm) vs chemoimmunotherapy (Ch+Imm) in 1L treatment of pts with MZL. 3 year OS: 84.9% in Imm & 83.6% in Ch+Imm, supporting the use of Imm alone in this setting. #lymsm (@lymphomahub)

Real world data on MZL treatment in the US presented by @lymphomatic looking at immuno- vs chemoimmunotherapy in MZL; propensity score matching with no difference in OS overall and pts with SMZL did worse with addition of chemo #17ICML #lymsm (@AlexandraRojek)

Olszewski. Immuno- vs chemo immunotherapy in MZL, real life. OS no diff. Only SMZL poorer w combination. Supports immunotherapy alone. #17ICML (@Dr_Daniel_Molin)

Hey #lymsm #17ICML, re: the results of the IELSG39 trial (6 mos of doxy for stage I orbital MZL), how do you treat 1L OMZL? https://t.co/sSROtAYrGw (@majorajay)

Ferreri. Chlamydia psittaci eradication in ocular adnexa MZL. Prolonged Doxycycline. 6 mo, 4w on, 4w off. ORR 64% CRR 32%, median fu 86 mo. Med time to best resp 9 mo. Better than 3w schedule. 70% no need of chemo or RT after >7y. #17ICML (@Dr_Daniel_Molin)

@StefanoLuminari presenting a unified prognostic score for MZL - the MZL-IPI. Better performance than IPI, FLIPI and MALT-IPI. Great data. #lymSM #17ICML (@chanyooncheah)

CONGRESS|#17ICML|@StefanoLuminari reports data from the training (NF10) & validation (SPORE-MER) studies confirming the prognostic role of MZL-IPI in identifying pts at different risk of PFS & OS for all patients with MZL; data support the use of MZL-IPI in future studies #lymsm (@lymphomahub)

Dr Thieblemont presents IELSG47/MALIBU study of ibrutinib and rituximab in MZL. Excellent ORR and encouraging CR rates in both subtypes but shorter PFS in NMZL #17ICML #lymSM @LysaLymphoma (@chanyooncheah)

Marginal zone lymphoma IPI validation #17ICML, with the following 5 variables: - Hgb <12 - ALC <1.0 - platelets <100k - elevated LDH - extranodal or disseminated MZL-IPI predicts PFS & OS in low (0) vs intermediate (1-2) vs high (3-5) risk groups. #lymsm (@majorajay)

@c_thieblemont Rituximab+ibrutinib in untreated splenic and nodal MZL. Ibrutinib 2 y, 8 doses of R. n=30+15. CR 12 mo: 53%. PFS at 5 y: 86% and 59%. Splenic better DOR. Safe and effective. #17ICML (@Dr_Daniel_Molin)

Excellent summary slides on efficacy of various BTK inhibitors in R/R MZL by Dr. @c_thieblemont. #lymsm #17ICML (@majorajay)

MALIBU trial of R + ibr (560 mg dose x 2 yrs) in 1L MZL #17ICML - 45 pts, mostly SMZL - ORR 97%, but DOR & PFS much lower in NMZL compared to SMZL - 4% afib, 10 d/c, 13 dose reductions SMZL benefit is likely from R x 4, NMZL PFS drops off precipitously when ibr stops. #lymsm (@majorajay)

May we perform PET instead of CT in extranodal MZL staging? #17ICML (by @JuanAlderuccio) EMZL is largely FDG-avid, with a tend of correlation with tumor size. But be aware of FDG physiologic activity! Correlation with physical exam, endoscopy, CT and MRI 🧩 (@Fer_martinmoro)

@StefanoLuminari Prognostic model on MZL. MZL-IPI: anemia, thrombocytopenia, lymphopenia, LDH, EN or diss MZL. 3 risk groups (0, 1-2, 3-5 rf). Validated for both PFS, OS. #17ICML (@Dr_Daniel_Molin)

Prognostic index for marginal lymphoma MZL-IPI by @StefanoLuminari @icmlugano #17ICML (@j_marquet)

MZL-IPI: a prognostic score for entire spectrum of MZLs. @FIL_ETS and SPORE-MER study. #ICML2023 great talk @StefanoLuminari complimenti (@TSkrypets)

Very nice work by @StefanoLuminari developing and validating MZL-IPI at #17ICML with differential PFS and OS outcomes for each risk group with external validation; very clean work and fills a gap in application of risk scores to this lymphoma subtype #lymsm (@AlexandraRojek)

Is it a MALToma with extensive plasmacytic differentiation or a known myeloma involving skin? (@henryhmo)

MALT lymphoma? (@LyallPHPM)

It was great to catch up w/ @JuanAlderuccio of @SylvesterCancer at #17ICML on staging FDG-avidity in extranodal MZL by disease location, enhancing prognostication & personalizing treatment in EMZL & more! Stay tuned for our interviews! @icmlugano #LymSM #HemOnc (@VJHemOnc)

Happy to travel from @MayoClinic to @icmlugano to champion the REALYSA study in MZL 🇫🇷, and meet in-person with colleagues from the LEO 🇺🇸 and NF10 🇮🇹 studies. #ICML2023 Cc @LysaLymphoma @StefanoLuminari @DChihara (@ComeBommier)

MZL by E. Zucca #17ICML @icmlugano A highly biological and clinically heterogeneous group of lymphomas. Efficacy of BR regimen was previously proven by @geltamo @ant_salar (@DrMCanales)

Prof Zucca from Bellinzona is giving a great overview of MZL #lymsm #17ICML (@PaolaGhione_MD)

Den wissen. Stand von 2022 könnte man kennen, z.B.: Sekizawa et al. "Rapid progression of marginal zone B-cell lymphoma after COVID-19 vaccination (BNT162b2): A case report", Front. Med. 2022, Sec. Hematology https://t.co/3seGqeCKgp #Impfschaden #Impfschäden #Impfnebenwirkung (@B_A_f_H_)

ICML LBA👏 I+BR or R-CHOP R/R FL/MZL Ph3 SELENE Study ⁦@LNastoupilMD⁩ Lisocel R/R MCL: TRANSCEND NHL 001 study ⁦@michaelwangmd⁩ TRANSCEND FL: Ph2 lisocel R/R FL FranckMorschhauser BrECADD non-inf to eBEACOPP adv cHL ⁦⁦@BroeckelmannPJ⁩ https://t.co/eIPHtg1pr7 (@CwynKate)

🗣️:🇺🇲/👥:👨‍⚕️🩸🦀 1- Splenic Marginal Zone Lymphoma -Association with HCV- 2- HTLV1 associated adult T-cell leukemia 3- Multicentric Castelman (?) -HHV8- 4- GIT GvHD + CMV (@Dr_MSU)

Ibrutinib-Containing Regimens Remain of Interest Despite Agent’s Withdrawal in MCL and MZL @MayoClinic #lymsm #hematology https://t.co/FtHtlZznHN (@OncLive)

Is POD24 relevant in MZL? Yes! @NEpperla et al 524 pts, 27% POD 24 POD24 had ⬇️ OS (5y OS 75% vs 92%), ⬆️ risk of HT regardless of type of 1L therapy For further details: https://t.co/rUJWFucnhI @lymphomatic @NatalieGroverMD @AndreaAnampaG @nancybartlettMD #lymsm (@PallawiTorkaMD)

Sometimes MZL can have plasmacytic differentiation! Just a thought; could look at cd19 and Ig staining in plasma cells if positive and IgM resp, could just suggest mzl (@TanejaMD)