Gastric mucosa-associated tissue lymphoma (MALT lymphoma) is a rare mature B-cell neoplasm associated with H. pylori infection that is curable by antibiotics therapy alone.
The pathological diagnosis of gastric MALT lymphoma can be reached by histological examination, immunohistochemical staining and B-cell clonality analysis.
Management of MALT lymphoma
First-line treatment
Gastric MALT lymphoma: localised disease
- 1 or more lines of Helicobacter pylori eradication therapy should be offered, without any concurrent therapy, to people with H. pylori-positive gastric MALT lymphoma
- H. pylori eradication therapy should be considered for people with H. pylori-negative gastric MALT lymphoma
- consider 'watch and wait' (observation without therapy) for people with gastric MALT lymphoma that responds clinically and endoscopically to H. pylori eradication therapy but who have residual disease shown by surveillance biopsies of the stomach, unless high-risk features are present
- for people with residual MALT lymphoma after H. pylori eradication therapy who are at high risk of progression [H. pylori-negative at initial presentation or t(11:18) translocation], options include:
- chemotherapy (for example, chlorambucil or CVP) in combination with rituximab or
- gastric radiotherapy
- for people with progressive gastric MALT lymphoma, options include:
- chemotherapy (for example, chlorambucil or CVP) in combination with rituximab or
- gastric radiotherapy
Non-gastric MALT lymphoma
- chemotherapy (for example, chlorambucil or CVP) in combination with rituximab should be offered to people with non-gastric MALT lymphoma for whom radiotherapy is not suitable or who have disseminated disease and need treatment
- radiotherapy should be considered for people with localised disease sites of non-gastric MALT lymphoma, irrespective of stage
- consider 'watch and wait' (observation without therapy) for people with clinically non-progressive localised non-gastric MALT lymphoma that is unlikely to result in vital organ dysfunction, who are asymptomatic and for whom radiotherapy is not suitable.
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