MALT lymphoma medical therapy: Difference between revisions

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==Overview==
==Overview==
The optimal therapy for MALT lymphoma depends on the stage at diagnosis.


==Medical therapy==
==Medical therapy==

Revision as of 16:32, 2 February 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

The optimal therapy for MALT lymphoma depends on the stage at diagnosis.

Medical therapy

The various treatment options for gastric MALT lymphoma include:[1]

 
 
 
 
 
 
 
 
 
 
 
 
Treatment of gastric
MALT lymphoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Early stage
(localized)
 
 
 
 
 
 
 
 
 
Advanced stage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Antibiotic therapy
 
Radiation therapy
 
Surgery
 
Chemotherapy
 
Monoclonal antibodies
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Observation
 
Radiotherapy
 
Chemotherapy
 
Monoclonal antibodies

Early Stage MALT lymphoma of the Stomach

The treatment options for early stage (localized) gastric MALT lymphoma that is confined to the stomach include:[1]

1) Antibiotic therapy

  • Amoxicillin and other antibiotics are often the first treatment used for H. pylori infection in people with gastric lymphoma. They can be very effective in getting rid of H. pylori and causing the gastric lymphoma to go into remission. A combination of 2 or 3 antibiotics may be used.
  • Antibiotics may be given with drugs that lower the production of acid in the stomach, called proton pump inhibitors (PPI) such as omeprazole or H2-receptor antagonists such as ranitidine.
  • Antibiotics should be usually given for 10–14 days. This treatment is often very effective at shrinking the lymphoma. However, it can sometimes take several months for the treatment to be effective.
  • After treatment with antibiotics, gastroscopy is performed to visualize if the H. pylori are gone, if the lymphoma has shrunk, or if the lymphoma has not recurred. This is an important part of follow-up after treatment with antibiotic therapy.

2) Radiotherapy

3) Surgery

  • Surgery for gastric MALT lymphoma (partial or total gastrectomy) is sometimes done if the lymphoma remains after antibiotic therapy or if the gastric lymphoma progresses.

4) Chemotherapy

5) Monoclonal Antibodies

  • Monoclonal antibodies are a type of biological therapy that is effective in treating certain types of NHL. Rituximab, the anti-CD20 chimeric antibody, may be another option if antibiotics do not reduce the lymphoma.

Advanced Stage MALT lymphoma of the Stomach

  • More advanced gastric MALT lymphomas are often treated like follicular lymphoma. The treatment options for advanced stage gastric MALT lymphoma that is confined to the stomach include:[1]

1) Observation

  • People with gastric MALT lymphoma that is not progressing may be observed without being treated right away.

2) Radiotherapy

3) Chemotherapy

4) Monoclonal Antibodies

  • Rituximab, the anti-CD20 chimeric antibody, is another option if the gastric lymphoma is resistant to antibiotics, not associated with H. pylori infection, or if the lymphoma has relapsed.


If the disease is limited to the stomach (which is assessed with computed tomography), then 70-80% of patients will have a complete regression on treatment with antibiotic eradication of H. pylori. [2]

References

  1. 1.0 1.1 1.2 Treatment of MALT lymphoma of the stomach. Canadian Cancer Society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/malt-lymphoma/?region=on. Accessed on January 28, 2016
  2. Bayerdörffer E, Neubauer A, Rudolph B, Thiede C, Lehn N, Eidt S, Stolte M (1995). "Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group". Lancet. 345 (8965): 1591–4. PMID 7783535.


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