Table 4 Risk-adapted approach for treatment of SMZL patients in resource-poor settings

1 – Asymptomatic SMZL

“Watchful & waiting”

2.1. With hepatitis C co-infection

2.1. Interpheron alpha and ribavirin, or new antiviral drugs

2.2. Age < 65 years, no-comorbidities and low-risk (Hb > 100 g/L, > 100 x 10⁹/L platelets, LDH < 480 U/L and albumin > 3.5 g/dL)^a

2.2. Splenectomy

2.3. Age > 65 years, comorbidities or high-risk (Hb < 100 g/L, < 100 x 10⁹/L platelets, LDH > 480 U/L and albumin < 3.5 g/dL)^a

2.3. Rituximab weekly for 4 weeks

3.1. Not exposed to rituximab

3.1. Rituximab weekly for 4 weeks

3.2. Exposed to rituximab

3.2. Splenectomy (if not done) or fludarabine (4 to 6 cycles)

4 – High-grade B-cell NHL transformation

4. 6 to 8 cycles of R-CHOP +/- autologous SCT^b