Document Type
Article
Publication Date
10-18-2024
Abstract
Marginal zone lymphoma (MZL) can have varied presentations and pathologic features, including high Ki-67 expression ( > 20%) as well as increased numbers of large B cells (LC). However, there are limited data available demonstrating the prognostic significance of these variables in patients with MZL. In this multi-institutional retrospective cohort study of patients with MZL treated at 10 centers, we evaluated the association between the presence of Ki-67 expression and increased LCs on survival and risk of histologic transformation (HT). A total of 785 patients were included (60% with extranodal MZL, 20% with nodal MZL, and 20% with splenic MZL). Among the 440 patients with Ki-67 staining, 22% had high Ki-67 (Ki-67 >20%). The median progression-free survival (PFS) for patients with high Ki-67 was 5.4 years compared to 7.0 years for patients with low Ki-67 (HR = 1.45, 95%CI = 1.03-2.05). Ki-67 > 20% strongly correlated with high LDH level. The risk of HT was higher in patients with increased Ki-67 than those without (5-year risk, 9.8% vs 3.87%, p = 0.01). Twelve percent of patients had LC reported on biopsy with 6% having >10% LC. The presence of LC was associated with high Ki-67 (p < 0.001), but not associated with shorter PFS or overall survival (OS). The cumulative risk for HT was higher in patients with LC compared to those without LC (5-year risk, 9.4% vs 2.9%, p = 0.04). Receipt of anthracycline-based therapy did not impact PFS or OS in either group. Ki-67 staining >20% was a prognostic factor for worse survival and strongly correlated with elevated LDH. Novel therapies should be investigated for their potential ability to overcome the high-risk features in MZL. Our data reinforce the importance of obtaining biopsies at relapse or progression, particularly in patients with baseline high Ki-67 and increased LCs, given their increased risk for HT.
Recommended Citation
Grover, Natalie S.; Annunzio, Kaitlin; Watkins, Marcus; Torka, Pallawi; Karmali, Reem; Anampa-Guzmán, Andrea; Oh, Timothy S.; Reves, Heather; Tavakkoli, Montreh; Hansinger, Emily; Christian, Beth; Thomas, Colin; Barta, Stefan K.; Geethakumari, Praveen Ramakrishnan; Bartlett, Nancy L.; Shouse, Geoffrey; Olszewski, Adam J.; and Epperla, Narendranath, "Evaluation of Ki-67 Expression and Large Cell Content as Prognostic Markers in MZL: a Multicenter Cohort Study" (2024). Department of Medicine Faculty Papers. Paper 469.
https://jdc.jefferson.edu/medfp/469
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Language
English
Comments
This article is the author's final published version in Blood Cancer Journal, Volume 14, Issue 1, October 2024, Article number 182.
The published version is available at https://doi.org/10.1038/s41408-024-01162-z.
Copyright © The Author(s) 2024.