[Clinical features and prognosis of splenic marginal zone lymphoma with POD24].

Objective: To investigate the clinical characteristics, prognosis, and risk factors associated with disease progression within 24 months (POD24) after diagnosis in patients with splenic marginal zone lymphoma (SMZL) . Methods: Clinical data from 88 newly diagnosed SMZL patients treated at Ruijin Hospital, Shanghai Jiaotong University School of Medicine, between December 2009 and October 2022, were retrospectively analyzed. Patients were grouped based on the presence of POD24 for prognostic evaluation and comparison of clinical features. Results: There were 45 males (51.1% ) and 43 females (48.9% ), with a median age of 59 (24-82) years at the time of diagnosis. Ten (11.4% ) cases occurred POD24. The overall survival (OS) time and progression- free survival (PFS) time in the POD24 group were shorten than non-POD24 group [median OS time: 77 (11-159) months vs not reached, P<0.001; 15 (4-24) months vs 121 (24-154) months, P<0.001]. Univariate Cox analysis showed that Eastern Cooperative Oncology Group (ECOG) score ≥ 2 [HR=8.942 (95% CI 1.097-72.910), P=0.041], age-adjusted International Prognostic Index (aaIPI) score of high-risk [HR=5.070 (95% CI 1.256-20.461), P=0.023], POD24 [HR=14.049 (95% CI 3.339-59.107), P<0.001], occurrence of tissue transformation [HR=7.819 (95% CI 1.952-31.316), P=0.004], and disease unremission status after initial treatment [HR=6.080 (95% CI 1.439-25.690), P=0.014] were the influencing factors for OS in SMZL patients. Multivariate analysis showed that POD24 [HR=5.859 (95% CI 1.249-27.475), P=0.025] and occurrence of tissue transformation [HR=5.520 (95% CI 1.050-29.009), P=0.044] were independent prognostic factors affecting OS. Univariate logistic analysis showed that ECOG ≥ 2 [HR=7.556 (95% CI 1.498-38.110), P=0.014], high risk of aaIPI score [HR=5.500 (95% CI 1.378- 21.945), P=0.016], occurrence of tissue transformation [HR=8.000 (95% CI 1.759-36.383), P=0.007], and disease unremission status after initial treatment [HR=9.136 (95% CI 2.216-37.675), P=0.002] were the influencing factors of POD24. Multifactorial analysis showed that disease unremission after initial treatment [HR=8.253 (95% CI 1.681- 40.518), P=0.009] was an independent risk factor affecting POD24. Conclusions: POD24 and tissue transformation are independent poor prognostic factors for OS in SMZL patients. Patients with POD24 are at a higher risk of developing tissue transformation. The failure to alleviate the disease after initial treatment is an independent risk factor affecting POD24 patients.