In 2021, the U.S. Food and Drug Administration (FDA) approved zanubrutinib (Brukinsa) for adult patients with relapsed or refractory (R/R) marginal zone lymphoma. At the 64th Annual American Society for Hematology (ASH) Annual Meeting, researchers presented two-year follow-up data on zanubrutinib for marginal zone lymphoma from the Phase 2 MAGNOLIA study (Abstract #234). The study found that the therapy elicited sustained and durable responses within this patient population. 

According to Cancer Network, findings from the study include: 

• There was a 68.2% overall response rate and 25.8% complete response rate to treatment.
• The overall response rate was highest in those with nodal marginal zone lymphoma, followed by those with splenic and extranodal marginal zone lymphoma. Overall response rate was lowest (50%) with those whose marginal zone lymphoma subtype was unknown. 
• Complete response was highest for those with extranodal marginal zone lymphoma, followed by unknown and nodal subtypes. Splenic subtypes had the lowest complete response rate (8.3%). 
• Treatment responses occurred fairly quickly. By the 24-month mark, 72.9% of patients still had treatment responses. 70.9% saw progression-free survival, and overall survival was 85.9%. 
• Zanubrutinib was found to be safe and relatively well-tolerated. 7.4% of patients withdrew from the trial due to adverse events. Common adverse events included abdominal, muscle, and back pain, diarrhea or constipation, high blood pressure, fever, upper respiratory tract infections, bruising, and neutropenia (low neutrophil/white blood cell counts). 

Outside of marginal zone lymphoma, zanubrutinib is also used to treat patients with Waldenstrom’s macroglobulinemia, mantle cell lymphoma, and chronic lymphocytic leukemia (CLL). Learn more about zanubrutinib. 

What is Marginal Zone Lymphoma? 

Marginal zone lymphoma exists under the greater umbrella of non-Hodgkin’s lymphoma (NHL), or cancers that impact the lymphatic system. In this case, the “marginal zone” refers to an area of the lymph nodes defended by a specific type of B-cells, which is where this slow-growing cancer develops. Marginal zone lymphoma is characterized by the development of cancerous white blood cells which multiply uncontrollably. Without treatment, this cancer can spread to other areas of the body. 

There are three distinct subtypes of marginal zone lymphoma: extranodal, nodal, and splenic. However, as described above, some patients have unknown subtypes (or have not had their specific subtype diagnosed yet). Hepatitis C and inflammatory or autoimmune disorders have been linked to marginal zone lymphoma. Symptoms of this cancer can include:

• Fever with no known cause
• Appetite loss
• Swelling in affected areas
• Unexplained weight loss
• Nausea and vomiting 
• Heartburn, indigestion, or bloating 
• Enlarged tonsils, spleen, or liver 
• Chest or abdominal pain
• Skin rashes 

Treatment options include antibiotics (for infection-related MZL), stem cell transplants, targeted therapy, chemotherapy, and radiation therapy. There are also numerous drugs being explored in clinical studies.