How are B-cell gastric MALT lymphomas treated?

Updated: Feb 23, 2021
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Therapy for gastric MALToma

European Society for Medical Oncology (ESMO) guidelines for treatment of gastric marginal zone lymphoma of the MALT type include the following recommendations [30] :

  • Helicobacter pylori eradication therapy must be given to all gastric MALT lymphomas, independently of stage, and may be considered for  H pylori–negative cases
  • Following initiation o f Helicobacter pylori treament, testing should be  at least 6 weeks after starting eradication therapy and at least 2 weeks after PPI withdrawl to confirm eradication. 
  • If  Helicobacter pylori is persistant, alternative antibiotics and PPI should be considered
  • If eradicated, endoscopy assessment with biopsy should be done within 3 to 6 months to see regression of lymphoma.
  • After antibiotic treatment, radiation and systemic oncological therapies should be used, depending on the stage of disease
  • Radiotherapy might be the preferred option for localized disease (eg, 24–30 Gy to the stomach and perigastric nodes given in 3 to 4 weeks)
  • Chemoimmunotherapy is preferred in cases of histological transformation or contraindications to radiotherapy; patients with  t(11;18) will most probably be unresponsive to alkylating agents as a sole treatment
  • No accepted standard chemotherapy has been established, but oral alkylating agents (either cyclophosphamide or chlorambucil) or purine nucleoside analogues (fludarabine, cladribine) and the combination of rituximab and bendamustine or chlorambucil or linalidomide have shown benefit
  • No data support a rituximab maintenance strategy.
  • Aggressive anthracycline-containing regimens are not usually necessary and should be reserved for the few patients with a very aggressive clinical course or histological transformation
  • Surgery has no role in initial treatment

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