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S01
MARGINAL ZONE AND LYMPHOPLASMACYTIC NHL: LESS
COMMON, THOUGH STILL IMPORTANT, VARIANTS IN THE
ELDERLY PATIENT
Luca Arcaini
Department of Molecular Medicine, University of Pavia, Department
of Hematology Oncology, Pavia, Italy
Among indolent, low-grade B-cell lymphomas, the WHO
classifications comprises follicular lymphoma (FL), small
lymphocytic lymphoma, marginal zone lymphoma (of MALT,
nodal and splenic type) and lymphoplasmacytic lymphoma/
Waldenström’s macroglobulinemia. In the WHO classification
three marginal zone lymphoma entities are listed: splenic
B-cell marginal zone lymphoma, nodal marginal zone
lymphoma, and extranodal marginal zone B-cell lymphoma
of MALT type. Marginal zone B-cells have been demonstrated
to play role in the immune response to T-cell-independent
antigens and frequently display reactivity to self antigens.
Marginal zone B-cells are involved in various infectious and
autoimmune conditions andmarginal zone-relatedneoplasms
often retain the features of these cells. Many infectious agents
are involved in the pathogenesis of specific types of marginal
zone lymphomas (for instance Helicobacter pylori for gastric
MALT lymphoma, HCV for splenic and extranodal marginal
zone lymphoma, Chlamydia psittaci for MALT lymphoma
of the orbit and others). Waldenstrom’s macroglobulinemia
(WM) is lymphoplasmacytic NHL characterized by the
presence of a serum IgM monoclonal protein associated with
bone marrow infiltration. An oncogenic somatic mutation in
the MYD88 gene, leading to change of an aminoacid (leucine
to proline) at position 265, has been identified inWM patients
by whole genome sequencing. The MYD88 (L265P) mutation is
only rarely found in patients with other lymphoproliferative
disorders and is detectable in about 50% of patients with IgM-
MGUS.
Disclosure of interest:
Consultancy: Celgene, Roche, Bayer;
Research funding: Gilead; Advisory Board: Roche, Celgene,
Gilead, Sandoz
S02
GENERATING EVIDENCE ABOUT EFFECTIVENESS AND
VALUE
Gouri Shankar Bhattacharyya
In Charge Department of Medical Oncology, Medical Oncology,
Kolkata, West, India
Healthcare providers are often faced with dilemma of
uncertainty when treating patients. Reliance is placed on
published scientific literature in addition to their knowledge,
skills, experience, patient preferences to make the decisions.
Clinical practice guidelines are statements that include
recommendations intended to optimize patient care that
are based on systemic review of evidence and assessment
of benefit and harm of alternative care – options available
(effectiveness and value).
Unfortunately, most guidelines appear to be a dicta and do
not take into account that a “one-size-fit-all” is not the right
approach in healthcare; clinical practice guidelines must be an
evaluation of quality of relevant scientific literature, evidence
of efficacy and effectivity as well as harms of treatment.
This enables healthcare providers the best care for a unique
patient based on his/her choice.
Unfortunately, Geriatric Oncology has bigger issues and
problems in view of availability of data. Most guidelines
used in Geriatric Oncology or as a matter of fact in Medicine,
suffer from shortcomings in development. Dubious trust in
guidelines is the result of many factors including failure to
represent a variety of discipline in guideline development,
lack of transparency in how recommendations are derived
and rated and omission of a thorough external review process.
A trustworthy guideline must have the following character:
• Be based on a systematic review of the existing evidence;
• Be developed by a knowledgeable, multidisciplinary panel
of experts and representatives from key affected groups;
• Consider important patient subgroups and patient prefer-
ences, as appropriate;
• Be based on an explicit and transparent process that
minimizes distortions, biases, and conflicts of interest;
• Provide a clear explanation of the logical relationships
between alternative care options and health outcomes,
J O U R N A L O F G E R I A T R I C O N C O L O G Y 7 / 6 S 1 ( 2 0 1 6 ) S 1 – S 2 1
Av a i l a b l e o n l i n e a t
www. s c i e n c e d i r e c t . c omScienceDirect
1879-4068/Published by Elsevier Ltd.
SIOG 2016 – Invited Speakers Abstract Submission