How I treat MALT lymphoma: ‘a subjective interpretation of the gospel according to Isaacson….’

Mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) is an indolent B-cell lymphoma characterised by a fascinating interplay between chronic antigenic stimulation, an immune response insufficient for elimination of the antigen and a mucosal ‘battleground’. The archetype of this association is infection of the gastric mucosa with Helicobacter pylori (HP): a single course of antibiotic HP-eradication treatment may result in long-term remission in up to 80% of patients and is the gold standard for first-line therapy of HP-associated gastric MALT lymphoma. In extragastric or disseminated disease, treatment options range from wait and see in asymptomatic individuals to radiotherapy in localised stages, anti-CD20-antibodies in patients with low symptomatic burden and chemotherapy-based treatment or radio-immunotherapy in symptomatic disease. In addition, more refined immunomodulatory strategies beyond simple eradication of bacteria such as long-term use of the macrolide clarithromycin or the immunomodulatory drug lenalidomide are active. In view of the indolent clinical course, the least toxic individual treatment should be chosen in a disease usually not influencing overall survival in affected patients.

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MALT lymphoma: epidemiology, clinical diagnosis and treatment

Journal of Medicine and Life ◽

10.25122/jml-2018-0035 ◽

2018 ◽

Vol 11 (3) ◽

pp. 187-193 ◽

Cited By ~ 13

Author(s):

Petruta Violeta Filip ◽

◽

Denisa Cuciureanu ◽

Laura Sorina Diaconu ◽

Ana Maria Vladareanu ◽

...

Keyword(s):

Helicobacter Pylori ◽

B Cell ◽

Malt Lymphoma ◽

Cell Lymphoma ◽

Gastric Lymphoma ◽

Eradication Therapy ◽

B Cell Lymphoma ◽

Gastric Malt Lymphoma ◽

H Pylori

Primary gastric lymphoma (PGL) represents a rare pathology, which can be easily misdiagnosed because of unspecific symptoms of the digestive tract. Histologically, PGL can vary from indolent marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) to aggressive diffuse large B-cell lymphoma (DLBCL). During the years, clinical trials revealed the important role of Helicobacter pylori (H. pylori) in the pathogenesis of gastric MALT lymphoma. Infection with Helicobacter pylori is an influential promoter of gastric lymphomagenesis initiation. Long-term studies revealed that eradication therapy could regress gastric lymphomas.

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Very long term outcome of patients with gastric marginal zone B cell lymphoma of mucosa associated tissue (MALT) following Helicobacter pylori (Hp) eradication therapy

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7531 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7531-7531

Author(s):

C. Chini ◽

I. Proserpio ◽

M. E. Giudici ◽

G. Pinotti ◽

B. Pozzi ◽

...

Keyword(s):

Median Time ◽

Malt Lymphoma ◽

Eradication Therapy ◽

B Cell Lymphoma ◽

Gastric Malt Lymphoma ◽

Low Grade ◽

Term Outcome ◽

Long Term Outcome ◽

Histological Remission

7531 Background: Hp infection plays a decisive role in the pathogenesis of low-grade gastric MALT lymphoma and eradication therapy has become a widely accepted initial treatment of stage I disease. The aim of this study was to evaluate the long term outcome of patients (pts) with localized gastric MALT lymphoma exclusively treated with Hp eradication therapy. Methods: a prospective series of 62 newly diagnosed IE gastric MALT lymphoma pts (29M/33F) with median age of 63 years (range 27–87), referred to our department from June 1991 to January 2004 were evaluable for the study. Diagnosis was histologically proved and Hp status was evaluated. Staging was performed according to the modified Ann Arbor system. All pts received the triple eradicating therapy (OMC: omeprazole 20 mg bid, metronidazole 400 mg bid and clarithromycin 500 mg bid or OAC: omeprazole 20 mg bid, amoxycillin 1,000 mg bid and clarithromycin 500 mg bid) for one week. Response, evaluated every 6 months with multiple biopsies, was graded according to the Wotherspoon’s histologic scoring system. Results: Hp was eradicated in all patients, but 8 pts required a second line antibiotic therapy; symptoms disappeared or markedly diminished and endoscopic features improved in all pts. Histological remission (score 0–2) was observed in 57 pts (91.9%) after a median time of 6 months (range 2–72); 5 pts (8.1%) who failed to respond were referred to other treatments. With a median follow-up time of 76 months (range 12–162) the histological remission persists in 27/57 pts (47,4%); 21/57 pts (36.8%) have a continuous histological score fluctuation (from 0 to 4); 8/57 (14%) pts had an histological relapse (score 5) after a median time of 12 months (range 6–48) without Hp reinfection and 6 of them had a second spontaneous histological remission. The OS at 76 months is 93%. Only one patient died for an high grade gastric MALT lymphoma transformation. Conclusion: the majority of pts with gastric MALT lymphoma have a favourable long term outcome, independently of the pathological remission; eradication therapy may offer a real chance of cure. Watch and wait policy in agreement pts who failed to respond could be considered an option outside of clinical trial. No significant financial relationships to disclose.

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Long-term clinical outcome of gastric MALT lymphoma after eradication ofHelicobacter pylori: a multicentre cohort follow-up study of 420 patients in Japan

Gut ◽

10.1136/gutjnl-2011-300495 ◽

2011 ◽

Vol 61 (4) ◽

pp. 507-513 ◽

Cited By ~ 155

Author(s):

Shotaro Nakamura ◽

Toshiro Sugiyama ◽

Takayuki Matsumoto ◽

Katsunori Iijima ◽

Shouko Ono ◽

...

Keyword(s):

Clinical Outcome ◽

Malt Lymphoma ◽

Gastric Malt Lymphoma ◽

Follow Up Study ◽

Multicentre Cohort

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INFECTIOUS AETIOLOGY OF MARGINAL ZONE LYMPHOMA AND ROLE OF ANTI-INFECTIVE THERAPY

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2016.006 ◽

2016 ◽

Vol 8 ◽

pp. 2016006 ◽

Cited By ~ 14

Author(s):

Salvatore Perrone ◽

Gianna Maria D'Elia ◽

Alessandro Pulsoni

Keyword(s):

Malt Lymphoma ◽

Marginal Zone ◽

Case Reports ◽

Lymphocyte Activation ◽

Chlamydia Psittaci ◽

Gastric Malt Lymphoma ◽

First Line Therapy ◽

Causative Relationship ◽

Chronic Hcv

Marginal zone lymphomas have been associated with several infectious agents covering both viral and bacterial pathogens and in some cases a clear aetiological role has been established. Pathogenetic mechanisms are currently not completely understood, however the role of chronic stimulation of the host immune response with persistent lymphocyte activation represents the most convincing explanation for lymphoproliferation. Gastric MALT lymphoma is strictly associated with Helicobacter pylori infection and various eradicating protocols, developed due to increasing antibiotic resistance, represent the first line therapy. The response rate to eradication is good with 80% of response at 1 year; this finding is also noteworthy because recapitulates a cancer cured only by antibacterial approach and it satisfies the Koch postulates of causation, establishing a causative relationship between Hp and gastric MALT lymphoma. Patients with chronic HCV infection have 5 times higher risk to develop MZL, in particular an association with splenic and nodal MZL has been shown in several studies. Moreover, there is evidence of lymphoma regression after antiviral therapy with interferon+ribavirin, thus rising hope that new available drugs, extremely effective against HCV replication, could improve outcome also in HCV-driven lymphomas. The rare cases of MZL localized to orbital fat and eye conjunctivas have been associated with Chlamydia psittaci infection carried by birds. Efficacy of antibacterial therapy against C. psittaci are conflicting and generally poorer thain gastric MALT. Finally some case-reports will cover the relationship between primary cutaneous B-cell Lymphomas and Borrelia Burgdorferi.

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78 High Adenocarcinoma Risk After Diagnosis of Gastric MALT Lymphoma: A Long-Term Nationwide Study

Gastroenterology ◽

10.1016/s0016-5085(08)60067-0 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-12

Author(s):

Lisette G. Capelle ◽

Annemarie C. de Vries ◽

Caspar W. Looman ◽

M.K. Casparie ◽

Gerrit A. Meijer ◽

...

Keyword(s):

Malt Lymphoma ◽

Gastric Malt Lymphoma ◽

Nationwide Study

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Myeloablative Anti-CD20 Radioimmunotherapy +/- High-Dose Chemotherapy Followed by Autologous Stem Cell Support for Relapsed/Refractory B-Cell Lymphoma Results in Excellent Long-Term Survival

Oncotarget ◽

10.18632/oncotarget.1037 ◽

2013 ◽

Vol 4 (6) ◽

pp. 899-910 ◽

Cited By ~ 10

Author(s):

Julia Y Wagner ◽

Kathleen Schwarz ◽

Susanne Schreiber ◽

Burkhard Schmidt ◽

Hans-Jürgen Wester ◽

...

Keyword(s):

Stem Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

High Dose Chemotherapy ◽

High Dose ◽

Term Survival ◽

Stem Cell Support ◽

Anti Cd20 ◽

Cell Support

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Long-Term Clinical Outcomes of Gastric MALT Lymphoma: A Nationwide Multicenter Study in Korea

Frontiers in Oncology ◽

10.3389/fonc.2021.681689 ◽

2021 ◽

Vol 11 ◽

Author(s):

Joon Sung Kim ◽

Jun Chul Park ◽

Jong Yeul Lee ◽

Ji Yong Ahn ◽

Sun Hyung Kang ◽

...

Keyword(s):

Overall Survival ◽

Malt Lymphoma ◽

Case Series ◽

Stage Iii ◽

Gastric Malt Lymphoma ◽

University Hospitals ◽

Initial Stage ◽

Testing Stage ◽

H Pylori

BackgroundTreatment recommendations for gastric mucosa-associated lymphoid tissue (MALT) lymphoma are based on case series and expert opinions. Only a few previous studies have focused on the long-term outcomes of gastric MALT lymphoma, especially according to stage.MethodsPatients diagnosed with gastric MALT lymphoma from January 2000 to December 2018 at nine university hospitals in Korea were included. Clinical data of medical history, endoscopic features, histological diagnosis, results of Helicobacter pylori (H. pylori) testing, stage, treatment conditions, and outcomes were collected.ResultsA total of 1,163 patients was enrolled, and 97.6% (n=1,038) of patients were diagnosed as stage IE. 10-year overall survival (OS) for the entire population was 99.1% and was better for patients in stage IE compared with patients in stage III/IV (p=0.002). The 10-year OS for H. pylori-positive patients was better than that of H. pylori-negative patients (p=0.022). Multivariate analyses revealed initial stage III/IV as a prognostic factor associated with over-all survival.ConclusionThe majority of gastric MALT lymphoma patients are diagnosed at an early localized stage in Korea. The overall survival rate of gastric MALT lymphoma is excellent and is associated with the initial stage of the disease.

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