An international analysis evaluating frontline bendamustine with rituximab in extranodal marginal zone lymphoma

Juan Pablo Alderuccio, Luca Arcaini, Marcus P. Watkins, Anne W. Beaven, Geoffrey Shouse, Narendranath Epperla, Michele Spina, Alexandra Stefanovic, Jose Sandoval-Sus, Pallawi Torka, Ash B. Alpert, Adam J. Olszewski, Seo Hyun Kim, Brian Hess, Sameh Gaballa, Sabarish Ayyappan, Jorge J. Castillo, Lisa Argnani, Timothy J. Voorhees, Raya SabaSayan Mullick Chowdhury, Fernando Vargas, Isildinha M. Reis, Deukwoo Kwon, Jonathan S. Alexander, Wei Zhao, Dali Edwards, Peter Martin, Emanuele Cencini, Manali Kamdar, Brian K. Link, Constantine N. Logothetis, Alex F. Herrera, Jonathan W. Friedberg, Brad S. Kahl, Stefano Luminari, Pier Luigi Zinzani, Izidore S. Lossos

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Extranodal marginal zone lymphoma (EMZL) is a heterogeneous non-Hodgkin lymphoma. No consensus exists regarding the standard-of-care in patients with advanced-stage disease. Current recommendations are largely adapted from follicular lymphoma, for which bendamustine with rituximab (BR) is an established approach. We analyzed the safety and efficacy of frontline BR in EMZL using a large international consortium. We included 237 patients with a median age of 63 years (range, 21-85). Most patients presented with Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1 (n 5 228; 96.2%), stage III/IV (n 5 179; 75.5%), and intermediate (49.8%) or high (33.3%) Mucosa Associated Lymphoid Tissue International Prognosis Index (MALT-IPI). Patients received a median of 6 (range, 1-8) cycles of BR, and 20.3% (n 5 48) received rituximab maintenance. Thirteen percent experienced infectious complications during BR therapy; herpes zoster (4%) was the most common. Overall response rate was 93.2% with 81% complete responses. Estimated 5-year progression-free survival (PFS) and overall survival (OS) were 80.5% (95% CI, 73.1% to 86%) and 89.6% (95% CI, 83.1% to 93.6%), respectively. MALT-IPI failed to predict outcomes. In the multivariable model, the presence of B symptoms was associated with shorter PFS. Rituximab maintenance was associated with longer PFS (hazard ratio 5 0.16; 95% CI, 0.04-0.71; P 5 .016) but did not impact OS. BR is a highly effective upfront regimen in EMZL, providing durable remissions and overcoming known adverse prognosis factors. This regimen is associated with occurrence of herpes zoster; thus, prophylactic treatment may be considered.

Original languageEnglish
Pages (from-to)2035-2044
Number of pages10
JournalBlood Advances
Issue number7
StatePublished - Apr 12 2022


Dive into the research topics of 'An international analysis evaluating frontline bendamustine with rituximab in extranodal marginal zone lymphoma'. Together they form a unique fingerprint.

Cite this