EHA 2022 | Emerging treatment options for MZL

Today, we discussed within the educational session the treatments and the evolution of treatment in marginal zone lymphoma. The current strategies are based on immunochemotherapy, if we use systemic therapy. However, since the past few years, we had some interesting studies reporting results in marginal zone lymphoma with BTK inhibitors, with PI3 kinase inhibitors, with IMiDs, and even with cell therapy with CAR-T cells, particularly axi-cel and bispecifics with few patients only.

So regarding the BTK inhibitors, ibrutinib offered about 43% of response rate. And then zanubrutinib recently reported at the ASH meeting offered more response, particularly in terms of complete response, with a mild adverse event with zanubrutinib. PI3 kinase inhibitors are still very toxic with diarrhea, pneumonia, and colitis. So this agent even if the response rates are very interesting, about 50% to 70%, depending on the PI3 kinase inhibitors, I don’t think that in this very indolent disease, this is to be proposed to the patients. And then CAR-T cells, ZUMA-5 reported in 24 patients with marginal zone lymphoma, by Sattva Neelapu, at the last ASH meeting with some results that are less impressive than in other indolent lymphomas, such as the follicular lymphoma. However, the progression-free survival is interesting in the relapsed setting, and then we are waiting for more results with bispecifics, epcoritamab and mosunetuzumab.