MALT lymphoma medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{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 | {{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | A01 |A01=<div style="width: 12em; padding:0.2em;">'''Treatment of gastric <br> MALT lymphoma'''</div>}} | ||
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|. | {{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| }} | ||
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | B02 | {{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; | {{familytree |boxstyle=background: #DCDCDC;| |,|-|-|-|v|-|^|-|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;| | | | | | | | | {{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | | | | | |!| |}} | ||
{{familytree |boxstyle=background: #DCDCDC;| | | {{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.|}} | ||
{{familytree |boxstyle=background: #DCDCDC;| | {{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;| | |||
{{familytree/end}} | {{familytree/end}} | ||
== | ===Early Stage MALT lymphoma of the Stomach=== | ||
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. | |||
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> | |||
==References== | ==References== | ||
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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
- 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:[1]
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.
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
- ↑ 1.0 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
- ↑ 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.