Splenic marginal zone lymphoma study update, February 2024

A project update from Dr Ahmed Ludvigsen Al-Mashhadi.

I am truly grateful for this opportunity provided by EHA, and for EHA's effort in advancing research in a field that may otherwise be very difficult to explore.

The study includes patients diagnosed with SMZL between the years 2000 and 2016. As outlined on the main project page, SMZL is an extremely rare disease with no published randomized clinical trials on optimal treatment strategies.

We wish to investigate the long-term outcomes after splenectomy vs rituximab. This work will provide decision-making tools for clinicians that help them choose the best treatment strategy for individual patients.

In 2023, we:

  • Reviewed the medical records of study candidates and included 934 patients from 25 centers across 3 continents
  • Completed preliminary data analysis
  • Presented our data as a poster presentation at the ASH Annual Meeting and Exposition (held in December 2023)

We found that patients with SMZL had consistently favorable outcomes with both rituximab and splenectomy as an initial treatment strategy. Outcomes were favorable even after second or third-line treatment.

Surprisingly, the 10-year cumulative risk of histological transformation was high (17%)—but with good outcomes, despite transformation.

As our next steps, we will:

  • Complete our adjusted analysis comparing splenectomy to rituximab
  • Aim to construct a predictive model to guide treatment decisions despite the lack of randomized clinical trials
  • Carry out further explorations involving patients with high transformation risk and treatment specific outcomes

Furthermore, we're eager to explore late toxicities after different treatment modalities. We intend to do this through a nationwide population-based analysis of patients from the Nordic cohorts.

The EHA grant contributed significantly to costs relating to:

  • Travel
  • Statistical aid
  • Data management

The funding will be extremely valuable in the work that yet remains in this major collaborative endeavor.