Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 28, 2009; 15(32): 4009-4015
Published online Aug 28, 2009. doi: 10.3748/wjg.15.4009
Splenectomy with chemotherapy vs surgery alone as initial treatment for splenic marginal zone lymphoma
Rajko Milosevic, Milena Todorovic, Bela Balint, Miodrag Jevtic, Miodrag Krstic, Elizabeta Ristanovic, Nebojsa Antonijevic, Mirjana Pavlovic, Maja Perunicic, Milan Petrovic, Biljana Mihaljevic
Rajko Milosevic, Milena Todorovic, Miodrag Krstic, Nebojsa Antonijevic, Maja Perunicic, Milan Petrovic, Biljana Mihaljevic, Clinical Center of Serbia, 11 000 Belgrade, Serbia
Milena Todorovic, Miodrag Krstic, Milan Petrovic, Biljana Mihaljevic, Medical School, Belgrade University, 11 000 Belgrade, Serbia
Bela Balint, Miodrag Jevtic, Elizabeta Ristanovic, Military Medical Academy, 11 000 Belgrade, Serbia
Bela Balint, Institute for Medical Research, Belgrade University, 11 000 Belgrade, Serbia
Mirjana Pavlovic, Charles Smith College of Science, FAU, 33 431, Boca Raton, Fl, United States
Author contributions: Milosevic R collected the data and designed the research with Todorovic M, Balint B and Mihaljevic B; Jevtic M, Krstic M, Ristanovic E and Antonijevic N provided vital reagents and edited the manuscript; Todorovic M, Balint B and Petrovic M analyzed the data; Perunicic M performed the pathohistological analysis; and Milosevic R, Todorovic M, Balint B and Pavlovic M wrote the manuscript.
Correspondence to: Milena Todorovic, Assistant Professor, MD, PhD, Institute of Hematology, Clinical Center of Serbia, 11 000 Belgrade, Serbia. bb.lena@gmail.com
Telephone: +381-11-3065112
Fax: +381-11-3065112
Received: June 1, 2009
Revised: July 10, 2009
Accepted: July 17, 2009
Published online: August 28, 2009
Abstract

AIM: To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS).

METHODS: A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined. Splenectomy plus chemotherapy was applied in 20 patients, while splenectomy as a single treatment-option was performed in 10 patients. Prognostic factor and overall survival rate were analyzed.

RESULTS: Complete remission (CR) was achieved in 20 (66.7%), partial remission (PR) in seven (23.3%), and lethal outcome due to disease progression occurred in three (10.0%) patients. Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank = 0.056, P > 0.05). Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions, as measured by computerized tomography and ultra-sound (t = 2.558, P = 0.018). Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank = 5.244, P < 0.05). The analysis of factors interfering with survival (by the Kaplan-Meier method) revealed that gender, general symptoms, clinical stage, and spleen infiltration type (nodular vs diffuse) had no significant (P > 0.05) effects on the OS. The expression of other antigens (immunohistochemistry) also had no effect on survival-rate, as measured by a χ2 test (P > 0.05).

CONCLUSION: Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration; however, a larger controlled clinical study is required to confirm our findings.

Keywords: Splenic marginal zone lymphoma, Chemotherapy, Splenectomy, Clinical outcome