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{{MALT lymphoma}}
{{MALT lymphoma}}
{{CMG}}{{AE}}{{SR}}
{{CMG}}{{AE}}{{SR}}, {{AY}}


==Overview==
==Overview==
The optimal therapy for MALT lymphoma depends on the stage at diagnosis. The treatment options for early stage (localized) gastric MALT lymphoma include [[antibiotic therapy]], [[radiotherapy]], [[chemotherapy]], [[surgery]], and [[monoclonal antibodies]].<ref name=treatmentofMALTlymphomaofthestomachrx1>Treatment of MALT lymphoma of the stomach. Canadian Cancer Society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/malt-lymphoma/?region=on. Accessed on January 28, 2016</ref> The treatment options for advanced stage gastric MALT lymphoma include observation, [[radiotherapy]], [[chemotherapy]], and [[monoclonal antibodies]].<ref name=treatmentofMALTlymphomaofthestomachrx1>Treatment of MALT lymphoma of the stomach. Canadian Cancer Society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/malt-lymphoma/?region=on. Accessed on January 28, 2016</ref>


==Medical therapy==
==Medical therapy==
The various treatment options for MALT lymphoma include:
The various treatment options for gastric MALT lymphoma include:<ref name=treatmentofMALTlymphomaofthestomachrx1>Treatment of MALT lymphoma of the stomach. Canadian Cancer Society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/malt-lymphoma/?region=on. Accessed on January 28, 2016</ref>


{{familytree/start |summary=Treatment of MALT lymphoma}}
{{familytree/start |summary=Treatment of gastric MALT lymphoma}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | A01| | | | | | | | | | | | | |A01=<div style="width: 12em; padding:0.2em;">'''Treatment of MALT lymphoma'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | A01 |A01=<div style="width: 12em; padding:0.2em;">'''Treatment of gastric <br> MALT lymphoma'''</div>}}
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{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| }}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | B02 | | | | | | | | | | | | | | | |B01=<div style="width: 12em; padding:0em;">'''Early stage<br>(localized)<br>''' </div>|B02=<div style="width: 12em; padding:0em;">'''Advanced stage'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | B02 |B01=<div style="width: 12em; padding:0em;">'''Early stage<br>(localized)<br>''' </div>|B02=<div style="width: 12em; padding:0em;">'''Advanced stage'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | F01 | | | | | | | | | | F02 | | | | | | | | | | | | | | | |F01=<div style="width: 12em; padding:0em;">'''WHO grade I / II''' </div>|F02=<div style="width: 12em; padding:0em;">'''WHO grade II'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| |,|-|-|-|v|-|^|-|v|-|-|-|v|-|-|-|.| |!| |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | | | | | | | | | | | |}}
{{familytree |boxstyle=background: #DCDCDC;| D01 | | D02 | | D03 | | D04 | | D05 |!| |D01=<div style="width: 9em; padding:0.2em;">'''Antibiotic therapy''' </div>|D02=<div style="width: 9em; padding:0.2em;">'''Radiation therapy'''</div>|D03=<div style="width: 9em; padding:0.2em;">'''Surgery'''</div>|D04=<div style="width: 9em; padding:0.2em;">'''Chemotherapy'''</div>|D05=<div style="width: 9em; padding:0.2em;">'''Monoclonal antibodies'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | C01 | | C02 | | C03 | | C04 | | | | | | | | | | | | | |C01=<div style="width: 9em; padding:0.2em;">'''[[Fibrillary astrocytoma]]''' </div>|C02=<div style="width: 9em; padding:0.2em;">'''[[Gemistocytic astrocytoma]]'''</div>|C03=<div style="width: 9em; padding:0.2em;">'''[[Protoplasmic astrocytoma]]'''</div>|C04=<div style="width: 9em; padding:0.2em;">'''[[Oligoastrocytoma]]'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | | | | | |!| |}}
{{familytree |boxstyle=background: #DCDCDC;| |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | | | | | | | | | | | | | | |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.|}}
{{familytree |boxstyle=background: #DCDCDC;| D01 | | D02 | | D03 | | D04 | | | | | | | | | | | | | | | | | | | | |D01=<div style="width: 9em; padding:0.2em;">'''[[Pilocytic astrocytoma]]''' </div>|D02=<div style="width: 9em; padding:0.2em;">'''Pilomyxoid astrocytoma'''</div>|D03=<div style="width: 9em; padding:0.2em;">'''[[Subependymal giant cell astrocytoma]]'''</div>|D04=<div style="width: 9em; padding:0.2em;">'''[[Pleomorphic xanthoastrocytoma]]'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | C01 | | C02 | | C03 | | C04 |C01=<div style="width: 9em; padding:0.2em;">'''Observation''' </div>|C02=<div style="width: 9em; padding:0.2em;">'''Radiotherapy'''</div>|C03=<div style="width: 9em; padding:0.2em;">'''Chemotherapy'''</div>|C04=<div style="width: 9em; padding:0.2em;">'''Monoclonal antibodies'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| E01 | | E02 | | E03 | | E04 | | | | | | | | | | | | | | | | | | | | |E01=<div style="width: 9em; padding:0.2em;">'''WHO grade I''' </div>|E02=<div style="width: 9em; padding:0.2em;">'''WHO grade II'''</div>|E03=<div style="width: 9em; padding:0.2em;">'''WHO grade I'''</div>|E04=<div style="width: 9em; padding:0.2em;">'''WHO grade II'''</div>}}
{{familytree/end}}
{{familytree/end}}
If the disease is limited to the stomach (which is assessed with [[computed tomography]]), then 70-80% of patients will have a complete regression on treatment with [[antibiotic]] eradication of ''H. pylori''. <ref>{{cite journal | author = Bayerdörffer E, Neubauer A, Rudolph B, Thiede C, Lehn N, Eidt S, Stolte M | title = Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group. | journal = Lancet | volume = 345 | issue = 8965 | pages = 1591-4 | year = 1995 | id = PMID 7783535}}</ref>


==Radiotherapy==
===Early Stage MALT lymphoma of the Stomach===
Others may be effectively controlled with the use of radiotherapy, or surgery. Both modalities may be curative in localized disease.
The treatment options for early stage (localized) gastric MALT lymphoma include:<ref name=treatmentofMALTlymphomaofthestomachrx1>Treatment of MALT lymphoma of the stomach. Canadian Cancer Society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/malt-lymphoma/?region=on. Accessed on January 28, 2016</ref>
 
====1) Antibiotic therapy====
*[[Amoxicillin]] and other antibiotics are often the first treatment used for [[helicobacter|H. pylori infection]] in people with gastric lymphoma. They can be very effective in getting rid of H. pylori and causing the gastric lymphoma to go into [[remission]]. A combination of 2 or 3 antibiotics may be used.
*Antibiotics may be given with drugs that lower the production of acid in the stomach, called [[proton pump inhibitors]] (PPI) such as [[omeprazole]] or [[H2-receptor antagonists]] such as [[ranitidine]].
*Antibiotics should be usually given for 10–14 days. This treatment is often very effective at shrinking the lymphoma. However, it can sometimes take several months for the treatment to be effective.
*After treatment with antibiotics, gastroscopy is performed to visualize if the H. pylori are gone, if the lymphoma has shrunk, or if the lymphoma has not recurred. This is an important part of follow-up after treatment with antibiotic therapy.
 
====2) Radiotherapy====
*[[External beam radiation therapy]] may be used if antibiotics don’t shrink the lymphoma or if the person is H. pylori negative.
 
====3) Surgery====
*[[Surgery]] for gastric MALT lymphoma (partial or total gastrectomy) is sometimes done if the lymphoma remains after antibiotic therapy or if the gastric lymphoma progresses.
 
====4) Chemotherapy====
*[[Chemotherapy]] is sometimes used if the lymphoma does not respond to antibiotic therapy. Drugs that may be used include single drugs such as [[chlorambucil]], [[cyclophosphamide]] or combinations like [[CHOP]] – [[cyclophosphamide]], [[doxorubicin]], [[vincristine]], and [[prednisone]].
 
====5) Monoclonal Antibodies====
*[[Monoclonal antibodies]] are a type of biological therapy that is effective in treating certain types of NHL. [[Rituximab]], the anti-CD20 chimeric antibody, may be another option if antibiotics do not reduce the lymphoma.
 
===Advanced Stage MALT lymphoma of the Stomach===
*More advanced gastric MALT lymphomas are often treated like [[follicular lymphoma]]. The treatment options for advanced stage gastric MALT lymphoma include:<ref name=treatmentofMALTlymphomaofthestomachrx1>Treatment of MALT lymphoma of the stomach. Canadian Cancer Society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/malt-lymphoma/?region=on. Accessed on January 28, 2016</ref>
 
====1) Observation====
*People with gastric MALT lymphoma that is not progressing may be observed without being treated right away.
 
====2) Radiotherapy====
*[[External beam radiation therapy]] may be used if the lymphoma is large, causing symptoms, or growing.
 
====3) Chemotherapy====
*[[Chemotherapy]] may be used instead of radiation therapy if the lymphoma is large, growing, widespread, or recurs.
*Chemotherapy drugs used are the same as those used for [[follicular lymphoma]]. These include single drugs like [[chlorambucil]], [[cyclophosphamide]], [[fludarabine]], or [[cladribine]].
*Chemotherapy can also include combinations of chemotherapy drugs, such as:
:*CVP – [[cyclophosphamide]], [[vincristine]], and [[prednisone]]
:*[[CHOP]] – [[cyclophosphamide]], [[doxorubicin]], [[vincristine]], and [[prednisone]]
 
====4) Monoclonal Antibodies====
*[[Rituximab]], the anti-CD20 chimeric antibody, is another option if the gastric lymphoma is resistant to antibiotics, not associated with H. pylori infection, or if the lymphoma has relapsed.
 


==Chemotherapy==
If the disease is limited to the stomach (which is assessed with [[computed tomography]]), then 70-80% of patients will have a complete regression on treatment with [[antibiotic]] eradication of ''H. pylori''. <ref>{{cite journal | author = Bayerdörffer E, Neubauer A, Rudolph B, Thiede C, Lehn N, Eidt S, Stolte M | title = Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group. | journal = Lancet | volume = 345 | issue = 8965 | pages = 1591-4 | year = 1995 | id = PMID 7783535}}</ref>
In contrast, if the disease has spread or has been [[refractory]] on antibiotics, [[chemotherapy]] may need to be considered.


==References==
==References==
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Latest revision as of 19:08, 18 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2], Ahmed Younes M.B.B.CH [3]

Overview

The optimal therapy for MALT lymphoma depends on the stage at diagnosis. The treatment options for early stage (localized) gastric MALT lymphoma include antibiotic therapy, radiotherapy, chemotherapy, surgery, and monoclonal antibodies.[1] The treatment options for advanced stage gastric MALT lymphoma include observation, radiotherapy, chemotherapy, and monoclonal antibodies.[1]

Medical therapy

The various treatment options for gastric MALT lymphoma include:[1]

 
 
 
 
 
 
 
 
 
 
 
 
Treatment of gastric
MALT lymphoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Early stage
(localized)
 
 
 
 
 
 
 
 
 
Advanced stage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Antibiotic therapy
 
Radiation therapy
 
Surgery
 
Chemotherapy
 
Monoclonal antibodies
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Observation
 
Radiotherapy
 
Chemotherapy
 
Monoclonal antibodies

Early Stage MALT lymphoma of the Stomach

The treatment options for early stage (localized) gastric MALT lymphoma include:[1]

1) Antibiotic therapy

  • Amoxicillin and other antibiotics are often the first treatment used for H. pylori infection in people with gastric lymphoma. They can be very effective in getting rid of H. pylori and causing the gastric lymphoma to go into remission. A combination of 2 or 3 antibiotics may be used.
  • Antibiotics may be given with drugs that lower the production of acid in the stomach, called proton pump inhibitors (PPI) such as omeprazole or H2-receptor antagonists such as ranitidine.
  • Antibiotics should be usually given for 10–14 days. This treatment is often very effective at shrinking the lymphoma. However, it can sometimes take several months for the treatment to be effective.
  • After treatment with antibiotics, gastroscopy is performed to visualize if the H. pylori are gone, if the lymphoma has shrunk, or if the lymphoma has not recurred. This is an important part of follow-up after treatment with antibiotic therapy.

2) Radiotherapy

3) Surgery

  • Surgery for gastric MALT lymphoma (partial or total gastrectomy) is sometimes done if the lymphoma remains after antibiotic therapy or if the gastric lymphoma progresses.

4) Chemotherapy

5) Monoclonal Antibodies

  • Monoclonal antibodies are a type of biological therapy that is effective in treating certain types of NHL. Rituximab, the anti-CD20 chimeric antibody, may be another option if antibiotics do not reduce the lymphoma.

Advanced Stage MALT lymphoma of the Stomach

  • More advanced gastric MALT lymphomas are often treated like follicular lymphoma. The treatment options for advanced stage gastric MALT lymphoma include:[1]

1) Observation

  • People with gastric MALT lymphoma that is not progressing may be observed without being treated right away.

2) Radiotherapy

3) Chemotherapy

4) Monoclonal Antibodies

  • Rituximab, the anti-CD20 chimeric antibody, is another option if the gastric lymphoma is resistant to antibiotics, not associated with H. pylori infection, or if the lymphoma has relapsed.


If the disease is limited to the stomach (which is assessed with computed tomography), then 70-80% of patients will have a complete regression on treatment with antibiotic eradication of H. pylori. [2]

References

  1. 1.0 1.1 1.2 1.3 1.4 Treatment of MALT lymphoma of the stomach. Canadian Cancer Society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/malt-lymphoma/?region=on. Accessed on January 28, 2016
  2. Bayerdörffer E, Neubauer A, Rudolph B, Thiede C, Lehn N, Eidt S, Stolte M (1995). "Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group". Lancet. 345 (8965): 1591–4. PMID 7783535.


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