Low grade B-cell non-Hodgkin lymphoma (LBNHL) is usually slow growing and most often incurable. Case 1: A 47-year-old Malay gentleman was diagnosed with relapsed Stage IV Grade 2 Follicular Lymphoma (Follicular lymphoma international prognostic index, FLIPI 2: intermediate risk). He was initially treated with 6 cycles of standard rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) polychemotherapy at first presentation and was in remission for 8 years until he relapsed with new inguinal lymphadenopathy and bone marrow involvement. He was re-treated with 6 cycles of rituximab-bendamustine (R-B), in which he is in complete remission for the past 2 years. Case 2: A 45-year old Malay female presented with previously untreated Stage IV extranodal marginal zone lymphoma of the left pleura with nodal and bone marrow involvement which did not respond adequately to 3 cycles of R-CHOP chemotherapy. Her unilateral pleural effusion was persistent, and she required re-treatment with 4 cycles R-B immunochemotherapy. She is now in complete remission for the past 18 months. Case 3: A 70-year old Malay gentleman was diagnosed with Waldenstrom macroglobulinemia without hyperviscosity syndrome. He was treated with 2 cycles of R-B immunochemotherapy. However, he developed worsening anemia. He was re-treated with 6 cycles of Bortezomib-Rituximab-Dexamethasone (B-R-D) immunochemotherapy, in which he is currently in complete remission for the past 16 months. Case 4: A 59-year-old Malay gentleman diagnosed with Stage IV non-TP53 mutated leukemic phase mantle cell lymphoma achieved complete remission after completing 6 cycles of intensive chemotherapy followed by consolidation autologous stem cell transplant.
Cite this paper
Kasinathan, G. (2020). Series of Low-Grade B-Cell Lymphoma: Follicular Lymphoma, Marginal Zone Lymphoma, Waldenstrom Macroglobulinemia and Mantle Cell Lymphoma. Open Access Library Journal, 7, e6759. doi: http://dx.doi.org/10.4236/oalib.1106759.
Swerdlow, S.H., Campo, E., Pileri, S.A., et al. (2016) The 2016 Revision of the World Health Organisation Classification of Lymphoid Neoplasms. Blood, 127, 2375-2390.
https://doi.org/10.1182/blood-2016-01-643569
Link, B.K. (2018) Transformation of Follicular Lymphoma-Why Does It Happen, and Can It Be Prevented? Best Practise & Research. Clinical Hematology, 31, 49-56.
https://doi.org/10.1016/j.beha.2017.10.005
Sriskandarajah, P. and Dearden, C.E. (2017) Epidemiology and Environmental Aspects of Marginal Zone Lymphomas. Best Practise & Research. Clinical Hematology, 30, 84-91. https://doi.org/10.1016/j.beha.2016.07.002
Thieblemont, C., Molina, T. and Davi, F. (2016) Optimizing Therapy for Nodal Marginal Zone Lymphoma. Blood, 127, 2064-2071.
https://doi.org/10.1182/blood-2015-12-624296
Xochelli, A., Kalpadakis, C., Gardiner, A., et al. (2014) Clonal B-Cell Lymphocytosis Exhibiting Immunophenotypic Features Consistent with a Marginal-Zone Origin: Is This a Distict Entity? Blood, 123, 1199-1206.
https://doi.org/10.1182/blood-2013-07-515155
Ott, G., Katzenberger, T., Lohr, A., et al. (2002) Cytomorphologic, Immunohistochemical, and Cytogenetic Profiles of Follicular Lymphoma: 2 Types of Follicular Lymphomagrade 3. Blood, 99, 3806-3812.
https://doi.org/10.1182/blood.V99.10.3806
Salama, M.E., Lossos, I.S. and Warnke, R.A. (2009) Immunoarchitectural Patterns in Nodal Marginal Zone B-Cell Lymphoma: A Study of 51 Cases. American Journal of Clinical Pathology, 132, 39-49. https://doi.org/10.1309/AJCPZQ1GXBBNG8OG
Vaxman, I., Bernstine, H., Kleinstern, G., Hendin, N., Shimony, S., Domachevsky, L., Gurion, R., Groshar, D., Raanani, P. and Gafter-Gvili, A. (2019) FDG PET/CT as a Diagnostic and Prognostic Tool for the Evaluation of Marginal Zone Lymphoma. Hematological Oncology, 37, 168-175. https://doi.org/10.1002/hon.2578
Ponzoni, M., Kanellis, G., Pouliou E, et al. (2012) Bone Marrow Histopathology in the Diagnostic Evaluation of Splenic Marginal Zone and Splenic Diffuse Red Pulp Small B-Cell Lymphoma: A Reliable Substitute for Spleen Histopathology? The American Journal of Surgical Pathology, 36, 1609-1618.
Owen, R.G., Treon, S.P., Al-Katib, A., et al. (2003) Clinicopathological Definition of Waldenstrom Macroglobulinemia: Consensus Pabnel Recommendations from the Second International Workshop on Waldenstrom Macroglobulinemia. Seminars in Oncology, 30, 110-115.
Pastore, A., Jurinovic, V., Kridel, R., et al. (2015) Integration of Gene Mutations in Risk Prognostification for Patients Receiving First-Line Immunochemotherapy for Follicular Lymphoma: A Retrospective Analysis of a Prospective Clinical Trial and Validation in a Population-Based Registry. The Lancet Oncology, 16, 1111-1122.
https://doi.org/10.1016/S1470-2045(15)00169-2
Lockmer, S., Ren, W.C., Brodtkorb, M., Østenstad, B., Wahlin, B.E. Pan-Ham- marström, Q. and Kimby, E. (2020) M7-FLIPI Is Not Prognostic in Follicular Lymphoma Patients with First-Line Rituximab Chemo Free Therapy. British Journal of Haematology, 188, 259-267. https://doi.org/10.1111/bjh.16159
Zucca, E. and Bertoni, F. (2016) The Spectrum of MALT Lymphoma at Different Sites: Biological and Therapeutic Relevance. Blood, 127, 2082-2092.
https://doi.org/10.1182/blood-2015-12-624304
Treon, S.P., Xu, L., and Hunter, Z. (2015) MYD88 L265P Mutations and Response to Ibrutinib in Waldenstrom Macroglobulinemia. The New England Journal of Medicine, 373, 584-586. https://doi.org/10.1056/NEJMc1506192
Marcus, R., Imrie, K., Solal-Celogny, P., Catalano, J.V., Dmoszynska, A., Raposo, J.C., Offner, F.C., Gomez-Codina, J., Belch, A., Cunningham, D., Wassner-Fritsch, E. and Stein, G. (2008) Phase III Study of R-CVP Compared with Cyclophosphamide, Vincristine, and Prednisolone Alone in Patients with Previous Untreated Advanced Follicular Lymphoma. Journal of Clinical Oncology, 26, 4579-4586.
https://doi.org/10.1200/JCO.2007.13.5376
Pott, C., Hoster, E., Kehden, B., et al. (2016) Minimal Residual Disease in Patients with Follicular Lymphoma Treated with Obinutuzumab or Rituximab as First-Line Induction Immunochemotherapy and Maintenance in the Phase 3 GALLIUM Study. Blood, 128, 613. https://doi.org/10.1182/blood.V128.22.613.613
Lopez-Guillermo, A., Canales, M.A., Dlouhy, I., et al. (2013) A Randomised Phase II Study Comparing Consolidation with a Single Dose of 90-Yttrium-Ibritumomab- Tiutexan (Zevalin) vs Maintenance with Rituximab Flor Two Years in Patients with Newly Diagnosed Follicular Lymphoma (FL) Responding to R-CHOP. Preliminary Results at 36 Months from Randomisation. Blood, 122, 369.
https://doi.org/10.1182/blood.V122.21.369.369
Montoto, S., Corradini, P., Dreyling, M., Ghielmini, M., Kimby, E., López-Guillermo, A., Mackinnon, S., Marcus, R.E., Salles, G., Schouten, H.C., Sureda, A. and Dreger, P. (2013) Indications for Hematopoietic Stem Cell Transplantation in Patients with Follicular Lymphoma: A Consensus Project of the EBMT-Lymphoma Working Party. Haematologica, 98, 1014-1021. https://doi.org/10.3324/haematol.2013.084723
Ruskone-Fourmestraux, A., Fischbach, W., Aleman, B.M., Boot, H., Du, M.Q., Megraud, F., Montalban, C., Raderer, M., Savio, A. and Wotherspon, A. (2011) EGILS Consensus Report. Gastric Extranodal Marginal Zone B-Cell Lymphoma of MALT. Gut, 60, 747-758. https://doi.org/10.1136/gut.2010.224949
Wirth, A., Gospodarowicz, M., Pintilie, M., et al. (2013) Long-Term Outcome for Gastric Marginal Zone Lymphoma Treated with Radiotherapy: A Retrospective Muti-Center, International Extranodal Lymphoma Study Group Study. Annals of Oncology, 24, 1344-1351. https://doi.org/10.1093/annonc/mds623
Salar, A., Domingo-Domenech, E., Panizo, C., et al. (2017) Long-Term Results of a Phase II Study of Rituximab and Bendamustine for Mucosa Associated Lymphoid Tissue Lymphoma. Blood, 130, 1772-1774.
https://doi.org/10.1182/blood-2017-07-795302
Dimopoulas, M.A., Zervas, C., Zomas, A., et al. (2002) Treatment of Waldenstrom Macroglobulinemia with Rituximab. Journal of Clinical Oncology, 20, 2327-2333.
https://doi.org/10.1200/JCO.2002.09.039
Kastritis, E., Gavriatopoulou, M., Kyrtsonis, M.C., et al. (2015) Dexamethasone, Rituximab and Cyclophosphamide as Primary Treatment of Waldenstrom Macroglobulinemia: Final Analysis of a Phase 2 Study. Blood, 126, 1392-1394.
https://doi.org/10.1182/blood-2015-05-647420
Gavriatopoulou, M., Garcia-Sanz, R., Kastritis, E., et al. (2017) BDR in Newly Diagnosed Patients with WM: Final Analysis of a Phase 2 Study after a Minimum Follow-Up of 6 Yrars. Blood, 129, 456-459.
https://doi.org/10.1182/blood-2016-09-742411
Hermine, O., Hoster, E., Walewski, J., et al. (2016) Addition of High-Dose Cytarabine to Immunochemotherapy Before Autologous Stem-Cell Transplantation in Patients Aged 65 Years or Younger with Mantle Cell Lymphoma: A Randomised, Open Label, Phase 3 Trial of the European Mantle Cell Lymphoma Network. The Lancet, 388, 565-575. https://doi.org/10.1016/S0140-6736(16)00739-X
Woyach, J.A., Furman, R.R., Liu, T.-M., et al. (2014) Resistance Mechanisms for the Bruton’s Tyrosine Kinase Inhibitor Ibrutinib. The New England Journal of Medicine, 370, 2286-2294. https://doi.org/10.1056/NEJMoa1400029
Bailly, C., Carlier, T., Touzeau, C., Arlicot, N., Kraeber-Bodéré, F., Le Gouill, S. and Bodet-Milin, C. (2019) Interest of FDG-PET in the Management of Mantle Cell Lymphoma. Frontiers of Medicin, 6, 70.
https://doi.org/10.3389/fmed.2019.00070
Visco, C., Chiappella, A., Nassi, L., et al. (2017) Rituximab, Bendamustine, and Low Dose Cytarabine as Induction Therapy in Elderly Patients with Mantle Cell Lymphoma: A Multicentre, Phase 2 Trial from Fondazion Italiana Linfomi. The Lancet Haematology, 4, E15-E23. https://doi.org/10.1016/S2352-3026(16)30185-5
