For marginal zone lymphoma with significant bone marrow involvement resulting in cytopenias and PRBC-transfusion dependence, do you have a preferred regimen to maximize bone marrow response? I'm seeing a 62 y/o M who was initially treated with rituximab single agent for symptomatic splenomegaly with good response but was lost to follow up, and now presented again with progressive splenomegaly/lymphadenopathy and 90-100% bone marrow involvement by lymphoma with Hgb 5-6, PLTs 20s. He has received 1 cycle of BR without much of a response.
MZL is the one low grade lymphoma where I sometimes give R-CHOP or R-CVP to debulk since the PFS benefit of BR was not demonstrated. It might work more quickly than BR. However, BR is certainly a good option and one cycle may not be enough time to see a response. Perhaps you can track response by measuring spleen size or nodes or checking flow in peripheral blood if he had circulating cells. If you're seeing a response, you may just need more time for counts to recover. I would save BTKi for later relapse.
