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.

Figure 1

Therapeutic algorithm for the stage dependent treatment of gastric MALT lymphomas based on the exact histopathology and thorough staging procedure. Patients stratification is orientated at three key decision points: (1) staging with endoscopic ultrasound (EUS), (2) H pylori (Hp) status, and (3) the presence of t (11; 18). As second line therapy in case of eradication non responders, radiation should be performed.