Understanding the practice landscape of marginal zone lymphoma in Southeast and East Asia

• Treatment initiation in MZL is driven by clinical urgency, balancing efficacy, toxicity, and cost considerations • Financial barriers significantly limit optimal care of MZL in Southeast and East Asia Marginal zone lymphoma (MZL) represents a diverse subgroup of non-Hodgkin lymphoma, with limited data to guide therapeutic decision making, particularly in Asian settings. To understand the factors for decision-making and the current management strategies for MZL in Asia, an online survey using a Best-Worst Scaling (BWS) instrument was conducted amongst hemato-oncologists (n = 18) representing eleven countries/territories in Southeast and East Asia. This was followed by a focus group discussion to refine the validity and interpretation of the survey results. Amongst all patients with MZL, approximately one-third are initially managed on a “watch and wait” strategy. The most important clinical characteristics influencing decision making for initiating systemic therapy include the presence of compression syndrome, followed by cytopenia and bulky disease. Both efficacy indicators such as “overall survival”, “overall response rate”, and “progression-free survival” as well as toxicity indicators “treatment-related cardiovascular-related side effects” and “treatment-related death” were rated as the topmost important factors in deciding treatment initiation for patients. In terms of treatment-related toxicities, cardiovascular side effects and death ranked as more important considerations, as compared with bleeding and infection risks. In addition, patient affordability was amongst the top considerations for initiating therapy, with financial barriers presenting as the major challenge for preferred use of BTK inhibitors and other standard therapies. Efficacy outcomes, balanced against treatment-related toxicity, are main considerations for systemic therapy initiation, and should be personalized for each patient. Financial barriers remain as the major challenge for the optimal treatment of patients with MZL in Asia.