MALT lymphoma medical therapy
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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]
Overview
Medical therapy
The various treatment options for gastric MALT lymphoma include:[1]
Treatment of 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 that is confined to the stomach include:
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.
Radiotherapy
- External beam radiation therapy may be used if antibiotics don’t shrink the lymphoma or if the person is H. pylori negative.
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.
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 (Adriamycin), vincristine, and prednisone.
Monoclonal antibodies
- Monoclonal antibodies are a type of biological therapy that is effective in treating certain types of NHL. Rituximab may be another option if antibiotics do not reduce the lymphoma.
Advanced stage MALT lymphoma of the stomach
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]
Radiotherapy
Others may be effectively controlled with the use of radiotherapy, or surgery. Both modalities may be curative in localized disease.
Chemotherapy
In contrast, if the disease has spread or has been refractory on antibiotics, chemotherapy may need to be considered.
References
- ↑ 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.