Should rituximab replace splenectomy in the management of splenic marginal zone lymphoma?

Publication date: Available online 7 November 2017 Source:Best Practice & Research Clinical Haematology Author(s): Christina Kalpadakis, Gerassimos A. Pangalis, Maria K. Angelopoulou, Sotirios Sachanas, Theodoros P. Vassilakopoulos Background SMZL is a relatively rare low grade B-cell lymphoma, characterized usually by an indolent clinical behavior. Since there is no prospective randomized trials to establish the best treatment approach, decision on therapeutic management should be based on the available retrospective series. Based on these data, rituximab and splenectomy appear to be the most effective. Splenectomy represented the standard treatment modality until early 2000s. More than 90% of the patients present quick amelioration of splenomegaly related symptoms along with improvement of cytopenias related to hypersplenism. The median progression free survival was 8.25 years in the largest series of patients published so far, while the median 5- and 10- year OS were 84% and 67%, respectively. Responses to splenectomy are not complete since extrasplenic disease persists. Patients with heavy bone marrow infiltration, lymphadenopathy or other disease localization besides the spleen are not good candidates for splenectomy. Furthermore splenectomy is a major surgical procedure accompanied by acute perioperative complications as well as late toxicities mainly due to infections. For that reasons splenectomy is not appropriate for elderly patients or patients with ...
Source: Best Practice and Research Clinical Haematology - Category: Hematology Source Type: research