First-line therapy and maintenance outcomes in Chinese patients with marginal zone lymphoma: a multicenter retrospective analysis with prognostic implications for chemotherapy decision-making

This multicenter retrospective study evaluated first-line treatment patterns, maintenance therapy outcomes, and prognostic factors in 171 newly diagnosed marginal zone lymphoma (MZL) patients treated across multiple centers in Fujian Province, China (2019-2024). The MALT subtype predominated (79.0%), with the gastrointestinal tract and lung being the most common primary sites. The first-line overall response rate was 91.1%, with 67.3% of patients achieving complete remission. Five-year progression-free survival (PFS) and overall survival (OS) were 82.6% and 94.7%, respectively. Maintenance therapy, received by 66.1% of patients, was associated with superior 5-year OS (100% vs. 87.5%, P=0.0104). Multivariate analysis identified Ki-67 >20% (HR=3.208, P=0.024) and high tumor burden (HR=4.670, P=0.003) as independent negative predictors for PFS, while high tumor burden (HR=4.493, P=0.004) and B symptoms (HR=3.324, P=0.030) predicted worse OS. Chinese MZL patients demonstrated favorable outcomes, and maintenance therapy conferred a significant OS benefit. Ki-67, tumor burden, and B symptoms serve as practical prognostic indicators to inform risk stratification and personalized treatment planning.