CD5 expression in marginal zone lymphoma predicts differential response to rituximab or bendamustine/rituximab

Abstract

We examined outcomes of 244 patients with marginal zone lymphoma (MZL) diagnosed in 2010–2020, of which 25 (10%) expressed CD5. CD5 expression was present in 22% of splenic, 8% of nodal, and 5% of extranodal MZL, and showed frequent blood/bone marrow involvement, elevated lactate dehydrogenase, and TP53 deletions. CD5 expression was not associated with progression-free or overall survival, but it conferred a significantly higher risk of histologic transformation (22% versus 4% at 5 years, p = 0.002). Among patients receiving first-line rituximab monotherapy, CD5 expression was associated with lower response rate (30% versus 77%, p = 0.006), PFS (25% versus 45% at 3 years, p = 0.003) and OS (44% versus 77%, p = 0.010), whereas CD5 status did not significantly affect outcomes of patients receiving bendamustine with rituximab (P for interaction = 0.012 for progression-free survival). CD5-positive MZL may have a propensity to leukemic dissemination, histologic transformation, and may derive benefit from first-line bendamustine/rituximab rather than rituximab alone.

Keywords:

• Marginal zone lymphoma
• CD5 expression
• bendamustine
• rituximab

Acknowledgements

Presented in part at the 62nd ASH Annual Meeting and Exposition December 5-8, 2020.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

AH, ASZ, AJO retrospectively reviewed all cases and collected data. HK reviewed cases and provided additional pathological testing and information. All authors wrote, revised, and approved the final manuscript.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Additional information

Funding

AJO reports research funding for the institution from Genentech/Roche, TG Therapeutics, Spectrum Pharmaceuticals, and Celldex, and grants from Adaptive Biotechnologies. This work was also supported by National Institute of General Medical Sciences. AJO is supported by the NIGMS pilot grant from the Advance-CTR program (grant U54GM115677). The Open Funder Registry entry for this grant is: https://taggs.hhs.gov/Detail/AwardDetail?arg_AwardNum=U54GM115677&arg_ProgOfficeCode=127, For documentation, the AJO award is listed on the Advance-CTR program site: https://advancectr.brown.edu/award-programs/awardee-archive/pilot-awardees. No other funding is associated with this work.