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The first randomised trial of first-line drug treatment for MALT lymphoma found that combining an old tablet with an antibody delayed relapse better than either alone, without anyone living longer.
Mucosa-associated lymphoid tissue lymphoma is common enough to matter and rare enough that nobody had randomised its systemic treatment. IELSG-19 did. The first 252 patients were randomised between chlorambucil alone and chlorambucil with rituximab; the protocol was then amended to a three-arm design adding rituximab alone, to a final 454 patients.
At a median follow-up of 7.4 years, five-year event-free survival was 51 per cent (95 per cent confidence interval 42 to 60) with chlorambucil alone, 50 per cent (42 to 59) with rituximab alone and 68 per cent (60 to 76) with the combination (p = 0.0009). The hazard ratio for the combination against chlorambucil alone was 0.54 (0.38 to 0.77). Progression-free survival also favoured the combination (p = 0.0119). Five-year overall survival was approximately 90 per cent in all three arms, and all treatments were well tolerated.
The practical reading: for MALT lymphoma that needs systemic treatment, the combination is the better choice if the aim is to stay in remission, and the near-identical survival across arms is a reminder that this disease rarely kills quickly. Most gastric cases never reach this trial at all, because eradicating Helicobacter pylori clears them.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
454 enrolled.
95 per cent confidence interval 60 to 76 · 42 to 60 · 42 to 59
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Event-free survival at 5 yearsprimary | Chlorambucil with rituximab | - | 68% | 0.54 (0.38 to 0.77) | 0.0009 | link |
| Chlorambucil alone | - | 51% | ||||
| Rituximab alone | - | 50% |
Shares International Extranodal Lymphoma Study Group, CD20, Rituximab, Rare and paediatric cancers without markets and the tag lymphoma-evidence.
Shares Watchful waiting, and how it differs from active surveillance, CD20, Rituximab, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.
Shares Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Marginal zone lymphoma, CD20, Trials enrol too few, too slowly and the tag lymphoma-evidence.
Shares Marginal zone lymphoma, CD20, Rituximab, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.
Shares Trials enrol too few, too slowly, Rituximab, Rare and paediatric cancers without markets, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.
Shares Watchful waiting, and how it differs from active surveillance, CD20, Rituximab, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.
Shares Rituximab, Rare and paediatric cancers without markets, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Monoclonal antibodies and the tag lymphoma-evidence.
Shares CD20, Rituximab, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Monoclonal antibodies and the tag lymphoma-evidence.