Treatment and Prognosis of Gastric MALT Lymphoma

ABSTRACT

Mucosa-associated lymphoid tissue (MALT) lymphomas represent 7% of all non-Hodgkin's lymphomas and can arise from any extranodal site; however, at least one-third of them present as a primary gastric lymphoma. Eradication of Helicobacter pylori (H. pylori) with antibiotics should be employed as the sole initial treatment of H. pylori-positive gastric MALT lymphoma. H. pylori eradication can induce lymphoma regression and long-term clinical disease control in most patients. In H. pylori-negative cases or patients who fail antibiotics therapy, irradiation and systemic therapies should be applied depending on the stage of disease; surgery has not been shown to achieve superior results in comparison with more conservative approaches in various trials. Lymphoma with diffuse large cell infiltration should be treated according to the recommendations for diffuse large cell lymphoma. H. pylori eradication resulted in complete lymphoma remission in the majority of cases. Most patients with minimal histological residuals of gastric MALT lymphoma after successful eradication of H. pylori had a favorable disease course without oncological treatment. A watch and wait strategy with regular endoscopies and biopsies appears to be safe and may become the approach of choice in this situation. Nevertheless, long-term careful endoscopic and systemic (blood counts and minimal adequate radiological or ultrasound examinations) follow-up once per year is recommended for all patients. This article is a review for the current treatment and prognosis of gastric MALT lymphoma.