Therapy of gastric mucosa associated lymphoid tissue lymphoma

Abstract

Gastric mucosa associated lymphoid tissue (MALT) lymphoma has recently been incorporated into the World Health Organization (WHO) lymphoma classification, termed as extranodal marginal zone B-cell lymphoma of MALT-type. In about 90% of cases this lymphoma is associated with H pylori infection which has been clearly shown to play a causative role in lymphomagenesis. Although much knowledge has been gained in defining the clinical features, natural history, pathology, and molecular genetics of the disease in the last decade, the optimal treatment approach for gastric MALT lymphomas, especially locally advanced cases, is still evolving. In this review we focus on data for the therapeutic, stage dependent management of gastric MALT lymphoma. Hence, the role of eradication therapy, surgery, chemotherapy and radiotherapy is critically analyzed. Based on these data, we suggest a therapeutic algorithm that might help to better stratify patients for optimal treatment success.

Recognition of changes in microvascular and microstructural patterns upon magnifying endoscopy predicted the presence of extranodal gastric MALToma

“…1,7 Ninety percent of patients with gastric MALToma were infected with H pylori. 8 Since the initial report on the regression of MALToma after H pylori eradication in 1993, there is a blooming interest in understanding the natural history and treatment for this uncommon disease.…”

Marginal Zone Lymphomas: Management of Nodal, Splenic, and MALT NHL

“…33 Most chemotherapy combinations report response rates of over 90% and purine analogue-based therapy ap- pears to have more efficacy but also more toxicity than alkylator-based therapy. 34 In fact, one publication indicated cases with t(11;18) tended to be poorly responsive to oral alkylator therapy. 35 Regression of established disease can be quite slow after H pylori eradication therapy, with some reports indicating a full year before complete remission was established.…”

The role of Helicobacter pylori in the pathogenesis of gastric malignancies

“…This MALT provides the necessary background in which gastric lymphomas can develop. Even though primary gastric lymphoma accounts for less than 3% of all nonHodgkin's lymphomas (NHL) and about 7% of all gastric neoplasms, the stomach is the most common site of extranodal NHL, with most gastric lymphomas being of B-cell origin [57,58] (Fig. 2).…”

“…CagA-positive strains of H. pylori have been especially associated with this more aggressive form of gastric lymphoma [73]. Since high-grade and low-grade forms of gastric lymphoma can occur simultaneously, H. pylori infection should always be sought and the infection eradicated to minimize low-grade tumor relapse [58], even when additional oncological therapy is given. Surprisingly, it may still be prudent to eradicate H. pylori as the initial therapy in MALT lymphomas that are negative for H. pylori , as some studies have shown successful regression of tumors without any further therapy [74].…”

“…The diffuse high-grade tumors are more frequently associated with specific gene translocations such as t(11;18) (q21;q21) [78] and gastric lymphomas that are positive for t(11;18) respond less well to H. pylori eradication [79]. The t(11;18) translocation results in a chimeric protein product (API2-MALT1) that translocates NF-kB into the nucleus to further promote lymphoma growth [58]. Due to the overall indolent nature of such tumors, however, patients who did not respond to H. pylori eradication were still able to reach CR following second-line treatments, such as radiation therapy, chemotherapy, and total gastrectomy [80].…”