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4394 Real World Patient Diagnostic and Treatment Patterns in Marginal Zone Lymphoma (MZL): First Results of the Prospective National MZL Registry of the German Lymphoma Alliance

Program: Oral and Poster Abstracts
Session: 623. Mantle Cell, Follicular, Waldenstrom’s, and Other Indolent B Cell Lymphomas: Clinical and Epidemiological: Poster III
Hematology Disease Topics & Pathways:
Research, Adult, Epidemiology, Clinical Research, Real-world evidence, Registries, Study Population, Human
Monday, December 9, 2024, 6:00 PM-8:00 PM

Alexander Grunenberg, MD1*, Birgit Schmelze2*, Jaqueline Gökeler3*, Heike Mund2*, Andreas Viardot, MD, PhD1, Jens Dreyhaupt4*, Gabriele Nagel5*, Marcel Reiser, MD6*, Thomas Gabrysiak7*, Friederike Braulke8*, Juergen Dunst9*, Rudolf Schlag, MD10*, Tobias Gaska, MD11, Volker Runde12*, Doris Kramer13*, Thomas Weber14*, Lothar Müller, MD15*, Patricia Johansson, MD16*, Carsten Ziske17*, Georg Hess, MD18* and Christian Buske, MD2

1Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
2Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
3University Hospital Ulm, Ulm, Germany
4Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
5University of Ulm, Ulm, Germany
6Praxis für internistische Onkologie und Hämatologie (PIOH), Frechen, Germany
7Onkologisches Zentrum, Wolfsburg-Helmstedt, Germany, Wolfsburg, Germany
8University Medical Center Goettingen, Goettingen, DEU
9Department of Radiotherapy, University Hospital Kiel, Kiel, Germany
10Practice for Hematology and Oncology Wuerzburg, Wuerzburg, Germany
11Brüderkrankenhaus St. Josef, Paderborn, Germany
12Wilhelm-anton-Hospital, Goch, Germany
13Kath. Krankenhaus Hagen gem. GmbH, St.-Josefs-Hospital Hagen, Hagen, Germany
14Department of Internal Medicine IV, Haematology and Oncology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
15Praxis Leer, Onkologie UnterEms, Leer, Leer, Germany
16Department of Haematology, University Hospital Essen, Essen, Germany
17St. Josef-Hospital Troisdorf, Practice Network Hematology and Intern. Oncology, Troisdorf,, Troisdorf, Germany
18University Clinic Mainz, Mainz, Germany

Background: Despite being the third most frequent B-cell lymphoma, marginal zone lymphoma (MZL) has been largely underrepresented in prospective clinical trials and registries. Based on this we initiated a prospective publicly funded registry for MZL with the primary objective to establish a comprehensive overview about clinical characteristics, diagnostic procedures and real-world treatment patterns for MZL patients.

Method: This prospective nationwide observational registry as part of the German Lymphoma Registry (GLA-R) based on 107 sites in Germany includes patients with MZL with mandatory reference pathology. Standardized data collection includes among others biological variables such as blastic morphology and proliferation rate with an arbitrary cut-off value >20% as proliferative active disease. Risk classification is calculated for each of MZL subtype based on the MALT-IPI for extranodal EMZL, the FLIPI for NMZL, and the simplified prognostic index of the SMZL Study Group for SMZL. Progression-free survival (PFS) and overall survival (OS) is calculated using the Kaplan-Meier method and applied the log-rank test for comparisons. All risk factors with a p-value <0.20 by univariate analysis were included in the multivariate Cox regression. P-values <0.05 are considered as statistically significant.

Results: Starting in 2015 the registry is actively recruiting and has included 822 patients until July 2024 so far. For this report records of 252 patients were centrally reviewed by a hematologist to ensure highest data quality. Median follow-up of the entire patient cohort was 4.5 years (95% CI: 4.2-4.9). 58% (n=145) belonged to the EMZL, 21%, (n=54) to the NMZL and 21 % (n=53) to the SMZL subtype. Gender was balanced and the median age at diagnosis was 64.5 years. For EMZL 55% of the patients belonged to the intermediate/high risk group, 66% for NMZL and 74% of patients with SMZL. Either blastic morphology and/or proliferative variant was reported in 11%. Evidence of monoclonal gammopathy was found in 34% of MZL with nearly every second case of NMZL showing monoclonal gammopathy (of these 52% with monoclonal IgM gammopathy, 36% with monoclonal IgG gammopathy). Every fifth patient did not obtain bone marrow (BM) biopsy at diagnosis, documenting that in the real-world setting many patients are managed without any information about BM involvement. PET-CT imaging was performed in 12% of the total cohort. Prior oncologic disease at the time of initial diagnosis of MZL was recorded in 17% (n=43) and history of autoimmune disease in 11% (n=27) with no major differences between subgroups.

Median PFS for the entire MZL patient cohort was 12.7 years (95% CI:7.9-NA) with a 5-year PFS of 66% (95% CI: 58-72) and a 5-year OS of 91% (95% KI 86-95). Median PFS (p=0.40) and OS (p=0.27) was comparable between the different subtypes. Also for NMZL PFS and OS was excellent with a median PFS of 9.2 years (95% CI 3.4-NA) and a 5-years OS of 85% (95% CI 70-92). In multivariate analysis, independent factors of shorter OS (p<0.01) were age (HR=1.11, 95% CI=1.04-1.18, p=0.001) and bone marrow infiltration (HR=8.95, 95% CI=2.03-39.40, p=0.004). Overall, POD24 frequency after systemic treatment approaches was observed in only 8% of cases. The 3 most common first-line treatments included immunochemotherapy (43%), local treatment (25%) and single agent anti-CD20 antibody treatment (13%). Within the group of patients who received immunochemotherapy, the two most common regimens were rituximab/bendamustine (74%) and R-CHOP (23%). One quarter of patients received local treatment as first line treatment. 18% (n=22/122) of patients treated with immunochemotherapy or single agent rituximab were assigned to rituximab maintenance. Of the 66 who progressed after front-line treatment and initiated second-line therapy, 43% received immunochemotherapy with rituximab/bendamustine being the most used regimen. At first relapse, immunochemotherapy was dominating in NMZL and SMZL, whereas in relapsed EMZL radiation, rituximab single agent treatment as well as anti-infectives played a major role.

Conclusion:

These prospective data provide a detailed and comprehensive overview about diagnostics and treatment choice for MZL in a real-world setting. They show that in the community diagnostic and clinical management of MZL is highly heterogenous and lacks a well defined standard approach.

Disclosures: Viardot: AbbVie, Amgen, Kite, Roche, Astra Zeneca: Membership on an entity's Board of Directors or advisory committees; AbbVie, BMS, Kite, Novartis, Roche, Sobi: Honoraria. Hess: Roche: Consultancy, Honoraria, Other: Travel support; MSD: Consultancy, Honoraria, Other: Travel support; Miltenyie: Consultancy, Honoraria, Other: Travel support; Lilly: Consultancy, Honoraria, Other: Travel support, Research Funding; Janssen: Consultancy, Honoraria, Other: Travel support, Research Funding; Incyte: Consultancy, Honoraria, Other: Travel support, Research Funding; BMS: Consultancy, Honoraria, Other: Travel support; BeiGene: Consultancy, Honoraria, Other: Travel support; AbbVie, ADC, AstraZeneca, BMS, Incyte, Janssen, Lilly, Miltenyie, Novartis, PiereFabre, F. Hoffmann-La Roche Ltd, Sobi: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria, Other: Travel Support; Abbvie: Consultancy, Honoraria, Other: Travel support, Research Funding; Incyte, AbbVie, Gilead/Kite, Janssen, Lilly, F. Hoffmann-La Roche Ltd: Research Funding. Buske: MSD: Research Funding; Lilly: Consultancy, Honoraria, Speakers Bureau; Sobi: Consultancy, Honoraria, Speakers Bureau; Regeneron: Consultancy, Honoraria, Speakers Bureau; MorphoSys: Consultancy, Honoraria, Speakers Bureau; Celltrion: Consultancy, Honoraria, Research Funding, Speakers Bureau; Gilead Sciences: Consultancy, Honoraria, Speakers Bureau; AbbVie: Consultancy, Honoraria, Research Funding, Speakers Bureau; Incyte: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; BeiGene: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Roche/Genentech: Consultancy, Honoraria, Research Funding, Speakers Bureau; Amgen: Research Funding.

*signifies non-member of ASH