Gastric MALT Lymphoma - Treatment Options and Prognosis

What are the Best Treatments for Gastric MALT Lymphoma?

What is gastric MALT lymphoma and how is it treated?. Credit: Istockphoto.com/Stock Photo©decade3d

What is gastric MALT lymphoma and how is it treated?

Gastric MALT Lymphoma - Definition

Gastric MALT lymphoma is a type of non-Hodgkin Lymphoma (NHL) affecting the stomach. To learn more about the symptoms and tests for this lymphoma see the article MALT Lymphoma.

Treatment Options for Gastric MALT Lymphoma

The following treatments can be used for gastric MALT lymphomas:

  • Treatment of Helicobacter pylori infection (antibiotics)

Let us look at how these different treatments fit in, in order of their effectiveness

Treatment of H. Pylori Infection

Many if not most cases of MALT lymphoma of the stomach are strongly associated with infection with H pylori.  H. pylori is a bacterium which is known to causes gastritis and stomach ulcers.  Just as the bacterium may harm the protective lining of the stomach and intestines to cause ulcers, it's thought that it may also lead to inflammation in the stomach which in turn can lead to cancer.  Since roughly half of the world has been infected with this bacteria, it does not cause problems for everyone, and probably acts in conjunction with other factors such as heredity and lifestyle to become a problem.

It has been seen that in those patients with MALT lymphoma who also test positive for H pylori, antibiotics for H pylori may actually completely control the cancer.

In 3 out of 4 patients with early disease, H pylori treatment may result in a complete resolution of the tumor. The disease remains controlled in many patients. Those with complete response may be kept on regular follow-up with endoscopies. Despite complete remission, some people will continue to have a positive PCR test for H.

pylori.

It's been found that some people who test negative for H. pylori infection respond to treatment with antibiotics with complete remission, so it could be argued that nearly anyone with a gastric MALT lymphoma should be treated with antibiotics known to eradicate H. pylori.

Radiation Therapy for MALT Lymphoma

Radiation is the preferred treatment for MALT lymphoma when H pylori is absent, or when anti H pylori treatment fails. Relatively low doses of radiation are given, and these doses nearly always control the lymphoma. Radiotherapy treatment alone can cause complete response in more than 95% of the patients, and most patients remain controlled in the long term.

Surgery for MALT Lymphoma of the Stomach

Surgery is an effective treatment of MALT lymphomas of the stomach and results in long term control in most patients. The risks of surgery are higher than those of radiation, and therefore surgery is less commonly used for treatment. Like radiotherapy, surgery is usually sufficient to control and cure MALT lymphomas that are limited to the stomach.

Chemotherapy for MALT Lymphoma

Chemotherapy is generally used for early stage gastric MALT lymphomas when local treatments fail to control disease, or when the disease recurs. For advanced stage stomach cancers, chemotherapy is the treatment of choice. Different combination treatments are effective in these slow growing lymphomas.

Immunotherapy for MALT Lymphoma

Rituxan (rituximab) is a monoclonal antibody which is effective in many forms of lymphoma including gastric MALT lymphoma.  Just as our bodies make antibodies to fight off bacteria and viruses, Rituxan is essentially a "man made antibody" which works to fight off cancer cells.  Just as our own antibodies recognize abnormal markers on the surface of bacteria, this medication "recognizes" a particular marker on the surface of certain cancer cells.

Coping and Support

Thankfully gastric MALT lymphoma is a very treatable cancer with an excellent prognosis.  That said, it's terrifying to be diagnosed with any cancer.  In addition, any treatments can be associated with side effects, especially fatigue.  Reach out to your family and friends.  Learn to let people help you.  And check out these tips that people have found helpful for coping with lymphoma.

Sources:

Gisbert, J., and X. Calvet. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Alimentary Pharmacology and Therapeutics. 2011. 34(9):1047-62.

Nakamura, S., and T. Matsumoto. Treatment Strategy for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma. Gastroenterology Clinics of North America. 2015. 44(3):649-60.

Nakamura, S., Sugiyama, T., Matsumoto, T. et al. Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobater pylori: a muticentre cohort follow-up study of 429 patients in Japan. Gut. 2012. 61(4):507-13.

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