This protocol applies to patients with splenic marginal zone lymphoma (SMZL) who have concomitant chronic hepatitis C virus (HCV) infection and whose disease did not achieve complete response following first-line rituximab monotherapy.
These patients carry a diagnosis of SMZL alongside active chronic HCV infection. In this setting, anti-HCV therapy is an important consideration throughout management, and antiviral treatment should be evaluated as part of the overall approach to HCV-associated lymphoma.
The preceding line of therapy was rituximab monotherapy. The threshold for escalation is failure to achieve complete response, defined as: resolution of organomegaly (spleen longitudinal diameter below threshold), normalisation of haemoglobin, platelet count, and neutrophil count, absence of circulating clonal B cells by flow cytometry, and no bone marrow infiltration on immunohistochemistry. Non-achievement of these endpoints triggers escalation to the current protocol.
For patients who have not responded to rituximab monotherapy, the protocol outlines an escalation strategy. The approach may involve adding chemotherapy to immunotherapy — particularly for fit patients with symptomatic or more advanced disease. The complete regimen, the full range of options, and the clinical criteria governing each are detailed in the structured protocol.
DOI: 10.1016/j.annonc.2019.10.010
In patients with concomitant chronic HCV infection who do not immediately need conventional treatment, antiviral therapy should be considered [IV, B].
Anti-HCV therapy should be considered in patients with HCV-associated lymphoma [IV, B].
For the patients who do not respond to rituximab, splenectomy [IV, B] or the addition of ChT may be considered.
Chemoimmunotherapy is particularly indicated for fit patients with symptomatic disseminated disease, constitutional symptoms and/or signs of high-grade transformation [III, B].
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