Table 4.

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

Clinical condition	Suggested approach
1 – Asymptomatic SMZL	“Watchful & waiting”
2 – Symptomatic SMZL
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 – Relapsed/Refractory SMZL
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 SCTb

^apresence of any adverse factors

^bconsider auto-SCT particularly after previous exposition to rituximab