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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-


Disclosure of interest:

Consultancy: Celgene, Roche, Bayer;

Research funding: Gilead; Advisory Board: Roche, Celgene,

Gilead, Sandoz




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 om


1879-4068/Published by Elsevier Ltd.

SIOG 2016 – Invited Speakers Abstract Submission