Given the paucity of data surrounding the prognostic relevance of monoclonal paraprotein (M-protein) in marginal zone lymphoma (MZL), we sought to evaluate the impact of detecting M-protein at diagnosis on outcomes in patients with MZL in a large retrospective cohort. The study included 547 patients receiving first-line therapy for MZL. M-protein was detectable at diagnosis in 173 (32%) patients. There was no significant difference in the time from diagnosis to initiation of any therapy (systemic and local) between the M-protein and no M-protein groups. Patients with M-protein at diagnosis had significantly inferior progression-free survival (PFS) compared with those without M-protein at diagnosis. After adjusting for factors associated with inferior PFS in univariate models, presence of M-protein remained significantly associated with inferior PFS (hazard ratio, 1.74; 95% confidence interval, 1.20-2.54; P = .004). We observed no significant difference in the PFS based on the type or quantity of M-protein at diagnosis. There were differential outcomes in PFS based on the first-line therapy in patients with M-protein at diagnosis, in that, those receiving immunochemotherapy had better outcomes compared with those receiving rituximab monotherapy. The cumulative incidence of relapse in stage 1 disease among the recipients of local therapy was higher in the presence of M-protein; however, this did not reach statistical significance. We found that M-protein at diagnosis was associated with a higher risk of histologic transformation. Because the PFS difference related to presence of M-protein was not observed in patients receiving bendamustine and rituximab, immunochemotherapy may be a preferred approach over rituximab monotherapy in this group and needs to be explored further.
Epperla, Narendranath; Zhao, Qiuhong; Karmali, Reem; Torka, Pallawi; Shea, Lauren; Oh, Timothy S.; Anampa-Guzmán, Andrea; Reves, Heather; Tavakkoli, Montreh; Greenwell, Irl Brian; Hansinger, Emily; Umyarova, Elvira; Annunzio, Kaitlin; Sawalha, Yazeed; Christian, Beth; Thomas, Colin; Barta, Stefan K.; Geethakumari, Praveen Ramakrishnan; Bartlett, Nancy L.; Grover, Natalie S.; and Olszewski, Adam J, "Impact of Detectable Monoclonal Protein at Diagnosis on Outcomes in Marginal Zone Lymphoma: A Multicenter Cohort Study" (2023). Department of Medicine Faculty Papers. Paper 426.
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