{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:25:10Z","timestamp":1790673910155,"version":"4.1.0"},"reference-count":26,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"17","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2017,6,10]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> There is no consensus on the optimal systemic treatment of patients with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. The IELSG-19 phase III study, to our knowledge, was the first such study to address the question of first-line treatment in a randomized trial. <\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p> Eligible patients were initially randomly assigned (1:1 ratio) to receive either chlorambucil monotherapy (6 mg\/m<jats:sup>2<\/jats:sup>\/d orally on weeks 1 to 6, 9 to 10, 13 to 14, 17 to 18, and 21 to 22) or a combination of chlorambucil (same schedule as above) and rituximab (375 mg\/m<jats:sup>2<\/jats:sup> intravenously on day 1 of weeks 1, 2, 3, 4, 9, 13, 17, and 21). After the planned enrollment of 252 patients, the protocol was amended to continue with a three-arm design (1:1:6 ratio), with a new arm that included rituximab alone (same schedule as the combination arm) and with a final sample size of 454 patients. The main end point was event-free survival (EFS). Analysis of chlorambucil versus the combination arm was performed and reported separately before any analysis of the third arm. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> At a median follow-up of 7.4 years, addition of rituximab to chlorambucil led to significantly better EFS (hazard ratio, 0.54; 95% CI, 0.38 to 0.77). EFS at 5 years was 51% (95% CI, 42 to 60) with chlorambucil alone, 50% (95% CI, 42 to 59) with rituximab alone, and 68% (95% CI, 60 to 76) with the combination ( P = .0009). Progression-free survival was also significantly better with the combination ( P = .0119). Five-year overall survival was approximately 90% in each arm. All treatments were well tolerated. No unexpected toxicities were recorded. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> Rituximab in combination with chlorambucil demonstrated superior efficacy in mucosa-associated lymphoid tissue lymphoma; however, improvements in EFS and progression-free survival did not translate into longer overall survival. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2016.70.6994","type":"journal-article","created":{"date-parts":[[2017,3,29]],"date-time":"2017-03-29T19:57:36Z","timestamp":1490817456000},"page":"1905-1912","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":179,"title":["Final Results of the IELSG-19 Randomized Trial of Mucosa-Associated Lymphoid Tissue Lymphoma: Improved Event-Free and Progression-Free Survival With Rituximab Plus Chlorambucil Versus Either Chlorambucil or Rituximab Monotherapy"],"prefix":"10.1200","volume":"35","author":[{"given":"Emanuele","family":"Zucca","sequence":"first","affiliation":[{"name":"Emanuele Zucca and Franco Cavalli, Oncology Institute of Southern Switzerland, Bellinzona; Luca Mazzucchelli, Cantonal Institute of Pathology, Locarno, Switzerland; Annarita Conconi, Ospedale degli Infermi, Biella; Giovanni Martinelli, European Institute of Oncology; Liliana Devizzi, Fondazione Istituto Nazionale Tumori; Valter Torri, Mario Negri Institute; Andr\u00e9s J.M. Ferreri, San Raffaele Scientific Institute; Maurilio Ponzoni, San Raffaele Hospital, Milan; Alessandra Tucci, Spedali Civili, Brescia;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annarita","family":"Conconi","sequence":"additional","affiliation":[{"name":"Emanuele Zucca and Franco Cavalli, Oncology Institute of Southern Switzerland, Bellinzona; Luca Mazzucchelli, Cantonal Institute of Pathology, Locarno, Switzerland; Annarita Conconi, Ospedale degli Infermi, Biella; Giovanni Martinelli, European Institute of Oncology; Liliana Devizzi, Fondazione Istituto Nazionale Tumori; Valter Torri, Mario Negri Institute; Andr\u00e9s J.M. 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Ferreri, San Raffaele Scientific Institute; Maurilio Ponzoni, San Raffaele Hospital, Milan; Alessandra Tucci, Spedali Civili, Brescia;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reda","family":"Bouabdallah","sequence":"additional","affiliation":[{"name":"Emanuele Zucca and Franco Cavalli, Oncology Institute of Southern Switzerland, Bellinzona; Luca Mazzucchelli, Cantonal Institute of Pathology, Locarno, Switzerland; Annarita Conconi, Ospedale degli Infermi, Biella; Giovanni Martinelli, European Institute of Oncology; Liliana Devizzi, Fondazione Istituto Nazionale Tumori; Valter Torri, Mario Negri Institute; Andr\u00e9s J.M. 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Ferreri, San Raffaele Scientific Institute; Maurilio Ponzoni, San Raffaele Hospital, Milan; Alessandra Tucci, Spedali Civili, Brescia;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Johnson","sequence":"additional","affiliation":[{"name":"Emanuele Zucca and Franco Cavalli, Oncology Institute of Southern Switzerland, Bellinzona; Luca Mazzucchelli, Cantonal Institute of Pathology, Locarno, Switzerland; Annarita Conconi, Ospedale degli Infermi, Biella; Giovanni Martinelli, European Institute of Oncology; Liliana Devizzi, Fondazione Istituto Nazionale Tumori; Valter Torri, Mario Negri Institute; Andr\u00e9s J.M. 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