名前：水原 健太郎【京都府立医科大学大学院医学研究科 血液内科学】
発表形式：e-Poster
Title:
Watchful waiting is an acceptable treatment option for primary ocular adnexal mucosa-associated lymphoid tissue lymphoma: A retrospective study
Authors:
Kentaro Mizuhara1, Tsutomu Kobayashi1, Mitsushige Nakao2, Ryoichi Takahashi3, Hiroto Kaneko4, Kazuho Shimura4, Koichi Hirakawa5, Nobuhiko Uoshima6, Yuri Kamitsuji6, Katsuya Wada7, Eri Kawata7, Reiko Isa1, Takahiro Fujino1, Yayoi Matsumura-Kimoto1, Taku Tsukamoto1, Shinsuke Mizutani1, Yuji Shimura1, Masafumi Taniwaki8, Junya Kuroda1
Affiliations:
1. Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
2. Department of Hematology, Otsu City Hospital, Otsu, Japan
3. Department of Hematology, Omihachiman Community Medical Center, Omihachiman, Japan
4. Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
5. Department of Hematology, Fukuchiyama City Hospital, Fukuchiyama, Japan
6. Department of Hematology, Japanise Red Cross Kyoto Daini Hospital, Kyoto, Japan
7. Department of Hematology, Matsushita Memorial Hospital, Moriguchi, Japan
8. Center for Molecular and Therapeutics, Kyoto Prefectural University of Medicine, Kyoto, Japan
Abstract:
Background: Primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML) is the most frequent subtype of ocular adnexal lymphomas. Radiotherapy (RT) is the standard of care for localized POAML, despite several complications, such as cataracts, retinitis, dry eye, and optic neuropathy. Watchful waiting (WW) is expected to be a therapeutic option for POAML, however, its efficacy for POAML remains to be verified.
Aims: The aim of the study was to clarify the validity of WW for POAML.
Methods: We retrospectively analyzed the background, disease status, treatments, and clinical outcomes of patients histologically diagnosed with POAML between 2008 and 2019 at seven institutes belonging to the Kyoto Clinical Hematology Study Group. The primary ocular adnexal disease sites were defined as involvement of the conjunctiva, orbit, eyelid, or lacrimal gland. Bilateral ocular adnexal lymphoma without other lymphomatous involvement was defined as stage IE disease.
Results: One hundred and three patients were diagnosed with POAML, of which 11 were excluded from analysis because of lost follow-up, 11 due to missing data, and 6 due to short follow-up within 1 year. As a result, 75 patients were analyzed in this study. The median age was 68 years, and 41 patients (54.7%) were females. The most common involved site was the conjunctiva (42.7%), followed by the orbit (36.0%), lacrimal gland (12.0%), and eyelid (8.0%). Sixty-nine patients (92.0%) presented with stage IE disease, and 61 patients (81.3%) presented with a unilateral ocular region. According to the International Prognostic Index, most patients (92.0%) were classified as low risk. The tumor was completely resected at diagnosis in 17 patients (22.7%), while a residual tumor existed after biopsy in 58 patients (77.0%). WW was the most frequent first-line modality, selected for 29 patients (38.7%), including 14 patients with complete tumor resection at diagnosis. Twenty-four patients (32.0%) were treated with RT and 19 (25.3%) with rituximab monotherapy (R). In the RT group, most patients had a residual tumor after the biopsy, and the orbit was the most frequent site of lymphoma, which caused treatment-emergent symptoms that potentially impair visual function. Complete response rates were 79.2% and 42.1% in the RT and R groups, respectively. With a median follow-up of 48.8 months, there were no significant differences in the time to start of new treatment between WW and RT groups (median: both not reached [NR], p = 0.187) and between WW and R groups (median: NR vs. 69.0 months, p = 0.554). At 60 months follow-up, the estimated proportions of POAML patients not requiring new treatment were 69.4%, 85.2%, and 53.8% in the WW, RT, and R groups, respectively. All patients enrolled in this study were alive at the time of analysis. In the WW group, 9 patients (31.0%) showed disease progression, seven of whom received treatments with a median time to next treatment of 15.6 months, but the remaining two patients continued WW even after disease progression because of no subject symptoms. In the RT group, 16 patients (66.7%) developed adverse events, most of which were mild, while grade 3 cataracts occurred in five patients. We compared the clinical characteristics to identify predictive factors for disease progression in the WW group, however, all factors analyzed were not significantly associated with disease progression.
Summary/Conclusion: WW may be an acceptable treatment option for POAML, especially in asymptomatic patients.
EHA2022参加レポート
この度はJSH Travel Award for EHA Congress 2022に採択いただきまして誠にありがとうございました。今回のEHAはオーストリアのウィーンでの現地開催とオンラインのハイブリッド開催となりましたが、依然として新型コロナウイルス感染状況の先行きが不透明であるためオンラインでの参加を選択しました。
私は今回、眼付属器原発MALTリンパ腫（POAML）に対する無治療経過観察（WW）の有用性に関する発表を行いました。POAMLに対する治療として放射線療法（RT）は非常に良好な局所制御率を示す一方、白内障やドライアイなどの晩期合併症が問題となります。我々はPOAMLに対するWWの有用性を明らかにするため本学と関連施設にて診断されたPOAML症例の患者背景、治療成績に関する後方視的解析を行いました。その結果、WWを選択した症例における新たな治療介入を要するまでの期間はRTやリツキシマブ単剤療法などの治療を実施された症例と同等であることが明らかとなりました。また病変部位や片側性もしくは両側性、診断時の切除範囲、腫瘍サイズなどは病状進行を予測する因子とならなかったことより、眼瞼下垂や複視などの症状を有しない場合はすべての症例においてWWが治療選択肢となりうることが示唆されました。
興味深い発表が多数ある中で、私は特にCAR-Tに関する発表に注目しました。欧州各国からreal-worldにおけるデータが報告されており、65歳以上の高齢者においても治療成績、安全性とも若年者と同等であることが示されていました。多くの演題で製剤別の治療成績、安全性の差に関して言及されており、今後の患者選択・製剤選択に有用なデータであると感じました。その他の分野でも今後の研究・臨床に活かすことができる新たな知見を得ることができました。
今回このような貴重な機会を与えていただきました日本血液学会国際委員会の先生方、事務局の皆様に厚くお礼申し上げます。また本研究に関してご指導いただきました黒田純也教授、古林勉先生、臨床データ収集にご協力いただきました関連施設の先生方に心より感謝申し上げます。
