MALT lymphoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2], Ahmed Younes M.B.B.CH [3]

The optimal therapy for MALT lymphoma depends on the stage at diagnosis. The treatment options for early stage (localized) gastric MALT lymphoma include antibiotic therapy, radiotherapy, chemotherapy, surgery, and monoclonal antibodies.^[1] The treatment options for advanced stage gastric MALT lymphoma include observation, radiotherapy, chemotherapy, and monoclonal antibodies.^[1]

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

The treatment options for early stage (localized) gastric MALT lymphoma include:^[1]

• 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.

• External beam radiation therapy may be used if antibiotics don’t shrink the lymphoma or if the person is H. pylori negative.

• 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.

• Chemotherapy is sometimes used if the lymphoma does not respond to antibiotic therapy. Drugs that may be used include single drugs such as chlorambucil, cyclophosphamide or combinations like CHOP – cyclophosphamide, doxorubicin, vincristine, and prednisone.

• 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.

• More advanced gastric MALT lymphomas are often treated like follicular lymphoma. The treatment options for advanced stage gastric MALT lymphoma include:^[1]

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

• External beam radiation therapy may be used if the lymphoma is large, causing symptoms, or growing.

• Chemotherapy may be used instead of radiation therapy if the lymphoma is large, growing, widespread, or recurs.
• Chemotherapy drugs used are the same as those used for follicular lymphoma. These include single drugs like chlorambucil, cyclophosphamide, fludarabine, or cladribine.
• Chemotherapy can also include combinations of chemotherapy drugs, such as:

• CVP – cyclophosphamide, vincristine, and prednisone
• CHOP – cyclophosphamide, doxorubicin, vincristine, and prednisone

• 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]

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