Thomas Habermann, MD, Mayo Clinic, explains differences in follicular lymphoma and marginal zone lymphoma.
Transcript:
Dr Thomas Habermann: I'm Tom Habermann from Mayo Clinic, Professor of Medicine at Mayo Clinic in Rochester, Minnesota.
Today we talked about the differences between follicular lymphoma and marginal zone lymphoma. These have tremendous implications for how we study these patients in clinical trials and interpret outcomes. They have very different biology.
The notch pathway is very important in marginal zone lymphoma and not in follicular lymphoma. The transformation rates are different. In our experience, the transformation rate and the mortality rates are as follows.
We, in follicular lymphoma, have reported that 80 percent of patients are alive and disease-free at 10 years and that of the deaths, 56% of them are lymphoma and half of those are transformation.
We previously reported on risks of transformation of being 2% per year in the rituximab era versus 3% before. The risk of transformation at 10 years in the Memorial Sloan Kettering experience was two percent. These are really different diseases with different biology.
In looking at how the types of marginal zone fall out, 60% are extranodal marginal zone lymphoma in a disease that has an incidence of about 7%, and a prevalence of about 8% in 2 different publications.
In looking at the outcomes, they're remarkably different in the types of extranodal lymphoma. Not only how we treat them and in what their survival rates are, much more different modalities are involved, surgery, radiation therapy, and other agents, and other approaches.
Gastric lymphoma, that's marginal zone. We start with antibiotic and other therapy, with quadruple therapy, and then potentially follow with radiation therapy in those patients who relapse, and they have tremendous outcomes in diseases such as parotid and salivary gland, pulmonary or BALT lymphoma, thyroid, small bowel. The management strategies, again, are multimodality in approach.
Of interest in clinical trials, splenomegaly may or may not be included as a definition in response criteria so this excludes splenic marginal zone lymphoma.
As we move on in the future, it's going to be very important to differentiate these diseases and to potentially recognize that they do have different natural histories, they do have different therapeutic interventions that are incredibly effective.
How we then interpret the new drugs with different mechanisms of action is going to all be dependent upon what kinds and what subsets of marginal zone lymphoma that we've defined and looked at.
