A CLINICAL ANALYSIS OF 2 INDOLENT LYMPHOMA ENTITIES - MANTLE CELL LYMPHOMA AND MARGINAL ZONE LYMPHOMA (INCLUDING THE MUCOSA-ASSOCIATED LYMPHOID-TISSUE AND MONOCYTOID B-CELL SUBCATEGORIES) - A SOUTHWEST-ONCOLOGY-GROUP STUDY

The objectives of this study were (1) to determine the clinical presen tation and natural history associated with two newly recognized pathol ogic entities termed mantle cell lymphoma (MCL) and marginal zone lymp homa (MZL), including the mucosa-associated lymphoid tissue (MALT) and monocytoid B-cell subcategories, and (2) to determine whether these e ntities differ clinically from the other relatively indolent non-Hodgk in's lymphomas with which they have been previously classified. We rev iewed the conventional pathology and clinical course of 376 patients w ho had no prior therapy; had stage III/IV disease; were classified as Working Formulation categories A, B, C, D, or E; and received cyclopho sphamide, doxorubicin, vincristine, prednisone (CHOP) on Southwest Onc ology Group (SWOG) studies no. 7204, 7426, or 7713. All slides were re viewed by the three pathologists who reached a consensus diagnosis. Ag e, sex, performance status, bone marrow and/or gastrointestinal involv ement, failure-free survival, and overall survival were compared among all the categories. We found that (1) MCL and MZL each represent appr oximately 10% of stage III or IV patients previously classified as Wor king Formulation categories A through E and treated with CHOP on SWOG clinical trials; (2) the failure-free survival and overall survival of patients with MZL is the same as that of patients with Working Formul ation categories A through E, but the failure-free survival and overal l survival of the monocytoid B-cell patients were higher than that of the MALT lymphoma patients (P = .009 and .007, respectively); and (3) the failure-free survival and overall survival of patients with MCL is significantly worse than that of patients with Working Formulation ca tegories A through E (P = .0002 and .0001, respectively). In conclusio n, patients with advanced stage MALT lymphomas may have a more aggress ive course than previously recognized. Patients with MCL do not have a n indolent lymphoma and are candidates for innovative therapy. (C) 199 5 by The American Society of Hematology.