Types of Lymphoma > Marginal
Zone Lymphomas >
MALT
Last update:
09/26/2011
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What is lymphoma?
Lymphoma is a blood cell cancer - a condition where abnormal
lymphocytes (a type of white blood cell) expand in number forming
tumors often in lymph nodes but also in other regions, such as the
bone marrow.
Lymphoma result when DNA
damage or changes occurs to an immune cell (a lymphocyte) that
alters the behavior of the cells.
The damage to DNA results in the
abnormal production of proteins that prevents the cells from dying
when they should, or causes sustained rapid cell division that
produces more of its kind.
These malignant cells then may accumulate
to form tumors that may enlarge the lymph nodes or spread to other
areas of the lymphatic system,
such as the spleen or bone marrow.
Lymphoma can also spread or first appear outside the
lymphatic system -- and is called extranodal
disease.
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MALT
stands for Mucosa-Associated
Lymphatic Tissue
MALT lymphoma has been reclassified as
extranodal Marginal zone lymphoma of mucosa-associated lymphoid
tissue (MALT)-type.
The abnormal lymphocytes (b-cells) can accumulate in areas outside the lymph nodes,
typically in mucosa tissue, such as the gastrointestinal
tract, breast, lung, thyroid, salivary glands,
eye, skin or soft tissues, or the skin.
Also
see Marginal Zone Lymphoma and Extranodal Lymphomas.
Management is different for gastric
(stomach) and non-gastric MALT.
Non- gastric MALT lymphomas are not
associated with H. pylori and are treated using standard modalities
that include radiation, chemotherapy, and monoclonal antibodies.
In the News:
Outlook
(prognosis) for MALT?
"The
outlook for people with gastric [and other ] MALT lymphoma is usually good with
about 80% of people surviving beyond the 5 year milestone and 77%
going on to have disease free survival at 10 years. "
Source: Fact file: Gastric MALT lymphoma, March 2005
by Dr Andrew Wotherspoon (sorry, the fact file is no longer
available)
What is the mucosa?
"The mucous membranes
line various body cavities that are exposed to the external
environment and internal organs.
It is at several places continuous with skin:
at the nostrils,
the lips,
the ears,
the genital
area, and the anus.
The sticky, thick fluid secreted by the mucous membranes and gland
is termed mucus.
The term mucous membrane refers to where they are found in the body"
Wikipedia.org
"Lymphoid tissue in the
human body is associated with the mucosal system. This tissue,
mucosa-associated lymphoid tissue (MALT), is scattered along
mucosal linings and protects the body from antigens
(non-belonging / invaders) entering
along mucosal surfaces."
emedicine
| Picture it
Also see "The Mucosal Immune System"
ncbi.nlm.nih.gov
for first-rate background on this aspect of the immune system.
Where
might MALT present?
"Most low-grade gastric
(stomach) lymphomas, and nearly half of all other gastric
lymphomas, are marginal zone B-cell lymphomas.
Extranodal
(outside the lymph nodes) marginal zone tumors may arise in the
stomach as well as the lungs, eye sockets, intestines, [skin], thyroid,
salivary gland, bladder, kidney, and even the central nervous
system (CNS).
What is the Incidence of MALT?
"In the US: non-Hodgkins Lymphoma (NHL) represents approximately 4% of all malignancies in the United States. MALT lymphomas comprise approximately 5% of all
non-Hodgkin's Lymphomas in the United States.
Internationally: According to worldwide literature, NHL accounts for 2-3% of all malignancies in the world and MALT lymphomas comprise approximately 5% of all
NHLs.
MALT lymphoma occurs in people from all geographic areas and all ethnic and racial groups. Although extensive studies have not been performed, no apparent strong predilection exists for MALT lymphomas in any particular identifiable group. "
Source:
emedicine.com
This type of lymphoma affects more women than men,
and the average age at diagnosis is 65 years.
Common
workup and monitoring of MALT
"The majority of
patients are diagnosed with localized, early-stage (Stage 1 or
2) extranodal disease. Many patients have a history of
autoimmune disease (disease caused by the body's immunologic
attacks against its own tissues) such as Sjögren's syndrome or
Hashimoto's thyroiditis, or bacterial infection of the stomach
with Helicobacter pylori.
Research findings suggest that
antibiotic therapy for Helicobacter pylori infection may prolong
remission in early gastric MALT lymphoma." Source: oncologychannel
Workup (adapted from NCCN Guidelines 2010)
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Staging tests (see
also below):
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CT of
Chest/abdominal/pelvic with contrast of diagnostic quality |
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Useful in select
cases:
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Endoscopic
ultrasound |
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Bone
marrow biopsy + aspirate |
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Physical exam:
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Exam with
attention to non-gastric sites (eyes, skin) |
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Performance status |
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B
symptoms (patient reported)
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Labs and tests:
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If negative for H. pylori
by histopathology,
do stool antigen, urea breath, and blood antibody tests. |
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CBC, differential,
platelets, |
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LDH |
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Comprehensive metabolic panel |
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Hepatitis B test (if Rituxan
considered) |
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Useful in select cases:
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Hepatitis C test
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Treatment, age and gender
specific:
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MUGA scan /
echocardiogram"
(prior to anthracycline-based therapy) |
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Discuss fertility issues |
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Pregnancy testing in women of
child-bearing age if chemo is planned |
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Staging
Staging
refers to the how widespread the disease is.
The Workup section above provides the most
common ways that staging is done for MALT. Extensive
staging in patients with mucosa-associated lymphoid tissue
(MALT)-type lymphoma can include:
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ophthalmologic examination
(evaluation of the eye)
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otolaryngologic investigation
(evaluation of the nose)
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gastroscopy with multiple biopsies
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endosonography* of upper gastrointestinal tract (About)
* a procedure in which an
endoscope is inserted into the body. An endoscope is
a thin, tube-like instrument that has a light and a
lens for viewing. A probe at the end of the
endoscope is used to
bounce high-energy
sound waves ( ultrasound)
off
internal organs to make a picture ( sonogram).
Also called
endoscopic ultrasound (EUS).
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enteroclysis (fluoroscopic
X-ray of the small intestine) (About)
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colonoscopy
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computed tomography of thorax and abdomen
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bone marrow biopsy
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Biopsy of lesions suggestive for lymphomatous involvement,
and evaluation of all biopsy specimens
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Source: Extensive staging in patients with mucosa-associated
lymphoid tissue (MALT)-type lymphoma
ncbi.nlm.nih.gov
"The importance of extensive staging in MALT-type lymphoma is
emphasized by the demonstration of multi-organ involvement in almost
a quarter of patients. In addition, our data suggest that
extra-gastrointestinal MALT-type lymphoma more frequently occurs
simultaneously at different anatomic sites than MALT-type lymphoma
involving the GI-tract."
Imaging
tests are used to estimate the stage:
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CT
scans
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MR imaging (MRI)
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PET scans,
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Gallium scans,
and
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Biopsies
(bone marrow, endoscopy)
are commonly
done to estimate the stage.
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Conditions
Associated with MALT
TOPIC SEARCH: ASCO
| Medscape
| Web
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H-pylori:
is associated with gastric MALT lymphomas (a definitive connection)
See About H Pylori patient.co.uk
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Sjögren syndrome:
is associated with MALTomas of the salivary glands
See Sjögren
Syndrome
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Hashimoto thyroiditis:
is associated with MALTomas of the thyroid.
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Crohn disease or
celiac disease: is associated with intestinal MALTomas |
"Continued massive antigen stimulation is postulated to
represent a critical step in the development and progression of
MALTomas."
Source: emedicine
"The list of microbial species associated
with MZ lymphoproliferations has grown longer with molecular
investigations and now comprises at least 5 distinct members:
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MZL/MALT are often infection-associated,
antigen-driven:
"H. pylori, C. jejuni, B. burgdorferi,
C. psittaci, and
hepatitis C virus (HCV), which have been associated with gastric
lymphoma, immuno-proliferative small intestinal disease, cutaneous
lymphoma, ocular lymphoma, and spleen lymphoma, respectively."
*
Source: Infection-associated lymphomas derived from marginal
zone B cells: a model of antigen-driven lymphoproliferation.
Blood. 2006 Apr 15;107(8):3034-44. Epub 2006 Jan 5. Review. PMID:
16397126 | Related
articles
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Monitoring MALT with PET?
Monitoring MALT with MRI?
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What is the Role Of
MRI In The Follow-Up Of Patients With Primary Gastric
Lymphoma? full
text article ispub.com
Conclusion: "Contrast-enhanced MR imaging is
effective for the precise extent of the disease and the
follow-up of patients with gastric MALT lymphoma, even though it
cannot detect flat mural lesions ((which is also a disadvantage
of CT imaging)." |
Recommended Resources for MALT
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MALT Lymphomas
http://bit.ly/8A9xiY
Franco Cavalli, Peter G. Isaacson, Randy D.
Gascoyne and Emanuele Zucca, 2001
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Pathology and Biology of Gastric MALT
PDF
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PDF eBooks on
Mucosa Lymphoma
pdfpick.com |
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Fact file: Gastric MALT lymphoma, March 2005
by Dr Andrew Wotherspoon (link no longer available)
The
outlook for people with gastric MALT lymphoma is usually good with
about 80% of people surviving beyond the 5 year milestone and 77%
going on to have disease free survival at 10 years.
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Other Resources
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Molecular subtyping of gastric MALT lymphomas: implications
for prognosis and management gut.bmjjournals.com
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Non-Hodgkins Lymphomas - Clinical Practice
Guidelines in Oncology – v.1.2006
nccn.org
professionals pdf
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Review article:
The gastric marginal zone B-cell lymphoma of MALT type bloodjournal.org
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MALT Diagnosis and Treatment Medscape
(free login req.)
(Scroll down tp view section on MALT)
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Lymphoma Diagnosis and
Treatment: CHOP, MALT, PET, and More
Medscape
(free login, req.)
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What's "Hot" in Hematologic Malignancy: Extranodal MALT Lymphoma: If You Exclude the Stomach, What's Left?,
Alexandra M. Levine, MD Medscape
(free login req.)
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Surgical Treatment of
Gastrointestinal B-Cell Mucosa-Associated Lymphoid
Tissue Lymphomas sma.org
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Marginal Zone Lymphoma hmds.org.uk
Clinical Features, Laboratory Diagnosis, Cytogenetics,
Transformation and Progression, and Outcome and Therapy
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Extranodal MALT (non-gastric)
based on areas of presentation
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Resources
based on areas of presentation
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OVERVIEW
of non-gastric MALT
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MALT Lymphomas - Radiological Spectrum of Disease
jradiology PDF
Good overview of areas of presentation.
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Non-gastrointestinal MALT: prognosis discussion
PDF
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See also MALT affecting the eye PAL |
BONE MARROW
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Bone marrow - comparative study of marginal zone lymphoma involving bone
marrow.
Am J Clin Pathol. 2002 May;117(5):698-708.
PMID: 12090417 PubMed
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BREAST
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Stage I and II MALT
lymphoma: results of treatment with radiotherapy.
Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):1258-64. PMID:
11483337 PubMed
| Related Abstracts
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CUTANEOUS (skin)
"Cutaneous lymphomas often have a more indolent natural history
than nodal lymphomas, and may require different therapeutic
approaches. Clinical features are an important prognostic factor and
should be utilized in guiding therapy. 1
"Primary cutaneous B-cell lymphomas have been associated
with Borrelia burgdorferi, the spirochete responsible for Lyme
disease. Recently, cutaneous marginal zone B-cell lymphoma has
been proposed as a distinct clinical-pathological entity." 5
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Cutaneous lymphomas: a proposal for a unified approach to
classification using the R.E.A.L./WHO Classification. Ann Oncol.
2000;11 Suppl 1:17-21. Review. PMID:
10707773
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Primary cutaneous marginal zone B-cell lymphoma: a molecular
and clinicopathologic study of 24 Asian cases.
Am J Surg Pathol.
2003 Aug;27(8):1061-9. PMID:
12883238
Cutaneous marginal zone B-cell lymphoma is a recently proposed
entity and constitutes a cutaneous counterpart of extranodal
marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
(MALT). Borrelia burgdorferi infection has been suggested as a
possible causative agent in European cutaneous cases of marginal
zone B-cell lymphoma
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Technical: mucosa associated lymphoid tissue lymphoma
translocation gene 1 PubMed
This gene has been found to be recurrently rearranged in
chromosomal translocation with two other genes - baculoviral IAP
repeat-containing protein 3 (also known as apoptosis inhibitor 2)
and immunoglobulin heavy chain locus - in mucosa-associated
lymphoid tissue lymphomas.
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Infection by Borrelia burgdorferi and cutaneous B-cell
lymphoma.
J Cutan Pathol. 1997 Sep;24(8):457-61. PMID:
9331890
Our results may have therapeutic implications. In analogy to
Helicobacter pylori-associated MALT-lymphomas, which in some cases
can be cured by eradication of Helicobacter pylori infection, a
proportion of CBCL may be cured with antibiotic therapy against
Borrelia burgdorferi. Although yet speculative, adequate
antibiotic treatment for patients with primary CBCL should be
considered before more aggressive therapeutic options are applied,
particularly in countries where infection by Borrelia burgdorferi
is endemic. PCR analysis of Borrelia burgdorferi DNA is a fast
test that should be performed in all patients with CBCL to
identify those who more likely could benefit from an early
antibiotic treatment.
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Eradication of Borrelia burgdorferi infection in primary
marginal zone B-cell lymphoma of the skin.
Hum Pathol. 2000
Feb;31(2):263-8. PMID:
10685647
A nearly complete clinical and histological regression was
observed after B burgdorferi eradication, with
immunohistochemistry studies showing disappearance of plasma cell
differentiation and a marked decline in the number of CD3+ T cells
and Ki-67+ cells. Our case confirms the link between B burgdorferi
and some cutaneous lymphomas.
Return to top
EYE (ocular)
TOPIC
SEARCH: PubMed
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Subtopic moved here: PAL
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Return to top
FORESKIN
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GASTRIC (stomach)
"In
the majority of people gastric MALT lymphoma is found during tests for
persistent indigestion - although only a very small percentage of
people with this symptom have lymphoma. The indigestion is
probably more related to the presence of the Helicobacter than the
actual lymphoma and patients are often symptomatically better
following its eradication, irrespective of whether the lymphoma is
decreasing (regressing).
A
very few people go to their doctor with other symptoms including
nausea and vomiting (possibly with specs of blood in the vomit) but
severe abdominal pain or the finding of a mass in the abdomen are
unusual." 1
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Fact file: Gastric MALT lymphoma, March 2005
by Dr Andrew Wotherspoon lymphoma.org.uk
Highly recommended synopsis, but no
longer available online.
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Gastric MALT lymphoma: from aetiology to treatment.
Lancet Oncol. 2002 Feb;3(2):97-104. Review. PMID: 11902529 PubMed
Return to top
Musshoff - classification of
gastrointestinal lymphomas
| IE |
Involvement of extralymphatic
organs or tissue |
| I1E |
In case of gastric lymphoma:
Involvement of mucosa and submucosa |
| I2E |
Gastric involvement
surpassing stage I1E |
| II1E |
Involvement of an
extralymphatic organ including regional lymphknots,
alternativly one further extralymphatic organ above or beneath
the diaphragma |
| II2E |
Involvement of an
extralymphatic organ and of extraregional lymph knots, plus
one additional localized involvement of an extralymphatic
organ |
| IIIE |
Involvement of an
extralymphatic organ, additionally involvement of lymph knots
above or beneath the diaphragma, including one further
localized involvement of an extralymphatic organ or tissue,
alternativly the spleen (IIIS) or both (IIIES) |
| IV |
Diffus or disseminated organ
involvement irrespective of lymph knot involvement |
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HEPATIC (Liver)
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[A case of MALT lymphoma of the liver treated by RFA and
Rituximab]
Nippon Shokakibyo Gakkai Zasshi.
2006 Jun;103(6):655-60. Japanese.
PMID: 16800289
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Primary low-grade hepatic B-cell lymphoma of mucosa-associated
lymphoid tissue (MALT)-type. Am J Surg Pathol. 1995
May;19(5):571-5. PMID:
7726367
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Extranodal lymphomas associated with hepatitis C virus
infection.
Am J Clin Pathol. 1998 May;109(5):600-9. PMID:
9576580 |
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LUNG - BRONCHUS-ASSOCIATED (BALT)
Related PubMed Articles
PubMed
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Lung (respiratory trac) BALT - Bronchus-associated lymphoid
tissue.
Represents ~10% of all MALT and ~ 60% of all Primary Pulmonary
Lymphomas.
Associated with Lupus erythematosa, Hashimoto thyroiditis,
Multiple sclerosis, and Sjögren syndrome. Source
jradiology PDF
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Related PubMed Articles
PubMed
NODAL ORIGIN
SALIVARY (PAROTID) GLAND
TOPIC
SEARCH: PubMed
"Mucosa associated lymphoid tissue (MALT)
lymphoma has been noted to involve the salivary glands in chronic
inflammatory conditions such as Sjogren's syndrome and in HIV
infection." 1
"Lymphoma arising from the parotid gland is
exceptionally rare. Indeed, primary parotid lymphoma accounts for only
0.3% of all cancer diagnoses." 2
"In general, malignant lymphoma originating in the parotid
gland is histologically described as low-grade non-Hodgkin's lymphoma,
frequently belongs to the B-cell type and rarely relapses into other
sites." 2
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Diagnosis and Treatment of Malignant Lymphoma of the Parotid
Gland jjco.oxfordjournals.org
Abstracts
MALT lymphoma presenting as a cystic salivary gland mass.
Head Neck. 2001 Mar;23(3):254-8. PMID:
11428457
Mucosa-associated lymphoid tissue lymphoma of the salivary
glands occurring in patients affected by Sjogren's syndrome:
report of 6 cases.
Acta Haematol. 2001;105(2):83-8. PMID:
11408709
Primary Salivary Gland Lymphoma: A Clinicopathologic Study
of 23 Cases in Taiwan karger.com
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SINUS
TOPIC SEARCH:
PubMed
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SPLENIC
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Monitoring
/ Imaging
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Monitoring
/ Imaging
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PET not judged effective for imaging of MALT: Positron emission tomography with fluorine-18-2-fluoro-2-deoxy-D-glucose (F18-FDG) does not visualize extranodal B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT)-type
Annals of Oncology, Vol 10, Issue 10 1185-1189, Copyright © 1999 by European Society for Medical Oncology
http://annonc.oupjournals.org
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Treatment
Also
see:
Treatment of non-follicular NHL - PDF
Questions for your doctor
- Patients
Against Lymphoma
General, Treatment & Side Effects, and Tests
Treatment Overview
ANTIBIOTIC THERAPY WHEN
H-PYLORI-NEGATIVE
Hi everyone, .I very rarely post, but usually read the daily digest
that comes in my e-mail. My husband was diagnosed with a malt lymphoma in his stomach almost
two years ago. He was diagnosed at the University of Utah with jumbo biopsies and internal ultrasound. Our GI Dr. seemed a little
leery about giving my husband the antibiotic treatment, but he did...and my husband has had no sign of the tumor since then. He
had a follow-up gastroscope with ultrasound at the U of U in May.
He also tested negative for H Pylori.....I think that there must
either be a different bacteria involved, or the tests for H Pylori
need a little perfecting!! I really don't think they are accurate...from all I've read!
~ DL (NHL-MALT)
I'm one of
those who had conjunctival malt successfully treated with doxycyline;
the treatment was based on the theory that antibiotics
were working for gastric malt (because of h. pylori), and the eye
shares a similar mucuous membrane with the stomach; thus, the
experiment with the doxycycline for conjunctival malt.
I think I was lucky to have a forward-thinking oncologist who was
working with some young colleagues; they proposed the antibiotic
treatment theory to me and it seemed to make sense. I figured I
had nothing to lose and everything to gain if it worked, and
thankfully it did. It certainly was a lot easier than the
radiation I had to the other eye.
~ Sherri (nhl-MALT)
Return to top
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TOPIC SEARCH:
All: ASCO
| Medscape
| Web
Antibiotics AND MALT: ASCO
| Medscape
| Web
Rituxan AND MALT: ASCO
| Medscape
| Web
Treatment Guidelines
Factors that determine
treatment timing and approach
The characteristics of the lymphoma at
diagnosis as determined by the pathology report, and it's actual
clinical behavior, and other factors determine the type of treatment
and the timing of treatment you and your doctor will consider.
What is the response rate to
initial antibiotic treatment of gastric MALT, and time to response?
"Our results showed 82.8 % of remission induction in low grade gastric MALTOMA by H pylori eradication alone with a single relapse.
About 50% of patients with low grade gastric MALTOMA showed complete remission by 4 months after H pylori eradication.
However, delayed response by up to 33 months occurred in one case.
Overall, complete remission was achieved within 12 months in 85 percentile.
We propose that it is necessary to wait for 12 months after initial eradication therapy of H pylori to define the time for H pylori eradication failure, because relapse is relatively rare after 12 months and nearby all the cases would have complete remission by 12 months. In addition, other treatment modalities could be used 12 months after initial H pylori eradication therapy, such as radiation therapy, surgery or chemotherapy.
" - World J
Gastroenterol 2004 January 15;10(2):223-226 Low
grade gastric MALToma: Treatment strategies based on 10 year follow-up
Frontline Antibiotics when
negative for H-Pylori?
A few patients have reported that antibiotics treatment has produced good results with MALT even when prior test indicated
negative for H-Pylori infection. But we have not located any studies
to support this practice.
See sidebar for one example.
TOPIC
SEARCH: Accuracy of H-pylori test: PubMed
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Case reports: Successful antibiotic treatment of
H-pylori negative gastric MALT lymphomas
http://bit.ly/6rQCG2
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Localized
Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation
Therapy Has Excellent Clinical Outcome.
J Clin Oncol. 2003 Nov
15;21(22):4157-4164. PMID:
14615444 | full
text
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MALT: The importance of monitoring for H. pylori
re-infection eurekalert.org
"The significance of the described work is that gastric
lymphoma progresses more rapidly upon secondary infection. Because
resting B cells are left behind following antibiotic treatment,
re-infection by H. pylori promotes the existing B cells to
progress quickly into tumors.
Therefore, it is important that
treated patients be carefully monitored for H. pylori
re-infection."
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Predictive factors for regression of gastric MALT lymphoma
after anti-Helicobacter pylori treatment
gut.bmjjournals.com
full
"This study showed that 56% of localised low grade MALT
GLs in H pylori positive patients achieved complete remission at
6-18 months after eradication of H pylori. In such
patients, H pylori infection was accurately assessed by
gastric histology and serology.
None of our H pylori negative GLs (23% of all cases)
regressed. This makes systematic eradication of the
bacteria, irrespective of H pylori status, of doubtful
significance. In carefully selected H pylori positive
patients without any lymph node involvement assessed by
EUS (Gastric endoscopic ultrasonography), complete remission was
achieved in 79% of cases. EUS proved more sensitive
than endoscopy or CT scan for accurate staging, which
was then crucial for predicting tumour response to
bacterial eradication.
Lymph node involvement, even when paragastric, and/or
tumour penetration beyond the submucosa, were indications of
little or no response. The persistence of an abnormal B cell clone
after H pylori eradication did not appear to affect the prognosis,
but longer follow up studies are needed to confirm this."
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First line Rituxan for MALT?
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Clinical activity of rituximab in extranodal marginal zone
B-cell lymphoma of MALT type. - full text bloodjournal.org
The overall response rate was 73% (95% confidence interval,
56%-87%), with 15 complete responses and 10 partial responses, and
the response rate was significantly higher in the
chemotherapy-naive patients, who had an 87% response rate compared
with 45% of the previously treated patients (P =.03). The median
response duration was 10.5 months. At a median follow-up of 15
months, 9 patients (26%) relapsed. The median time to treatment
failure was 14.2 months in the whole series, but it was
significantly longer (22 versus 12 months) in the
chemotherapy-naive patients compared with those who had prior
chemotherapy (P =.001). Most adverse events were of mild to
moderate severity with no grade 4 toxicity. This study indicates
that rituximab is safe with significant activity in MALT
lymphomas.
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Surgery for Gastric MALT?
"The treatment of gastric lymphoma continues
to evolve, and surgical resection is now uncommonly a part of the
initial management strategy."
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The Diminishing Role of Surgery in the Treatment of Gastric Lymphoma.
Annals of Surgery. 240(1):28-37, July 2004.
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Treatment resources and reports
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Nongastric MALT Lymphoma / Marginal Zone Lymphoma
- Treatment guidelines nccn.org
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New Therapeutic Strategies for Non-Hodgkin's Lymphoma: An Expert Interview With Dr. Richard Fisher
- ASH 2000
"Histological regression of the gastric lymphoma after anti-helicobacter
triple therapy was observed in 133 pts. (70%, 95% C.I., 63% to
77%) with 105 (55%) complete and 28 (15%) partial remissions. The
median time to lymphoma regression was 7 months."
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Rituximab-induced remission of a gastric MALT lymphoma.
Leuk Lymphoma. 2004 Jun;45(6):1297-9. PMID:
15360017
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Localized
Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation
Therapy Has Excellent Clinical Outcome.
J Clin Oncol. 2003 Nov
15;21(22):4157-4164. PMID:
14615444 | full
text
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Antibiotic treatment
of gastric lymphoma of mucosa-associated lymphoid tissue. An
uncontrolled trial. Ann Intern Med. 1999 Jul 20;131(2):88-95. PMID:
10419446 | Full
text
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Antibiotic treatment for conjunctival MALT? (also see
sidebar anecdote)
H. pylori molecular signature in conjunctival mucosa-associated
lymphoid tissue (MALT) lymphoma. Histol Histopathol. 2004
Oct;19(4):1219-26. PMID:
15375765
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Utility of surgical
resection with or without radiation therapy in patients with
low-grade gastric mucosa-associated lymphoid tissue lymphoma
Haematologica.org
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Clinical activity of rituximab in extranodal marginal zone
B-cell lymphoma of MALT type. Blood. 2003 Jul 3 [Epub ahead of
print] PMID: 12842999 PubMed
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Stage I and II MALT
lymphoma: results of treatment with radiotherapy.
Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):1258-64. PMID:
11483337 PubMed
| Related
Abstracts
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The primary gastric lymphoma: therapeutic strategies Romeo
Giuli MD
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Treatment outcome of mucosa-associated lymphoid
tissue/marginal zone non-Hodgkin's lymphoma.
Int J Radiat Oncol
Biol Phys. 2002 Mar 15;52(4):1058-66. PMID: 11958902 PubMed
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Conservative treatment of primary gastric low-grade B-cell
lymphoma of mucosa-associated lymphoid tissue: predictive factors
of response and outcome. Am J Gastroenterol. 2002 Feb;97(2):292-7. PMID: 11866264
PubMed
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Clinical Trials
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ClinicalTrials.gov searches by
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Prognosis
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Prognosis
"MALT-type
lymphoma has a better prognosis than gastric lymphomas, because it
tends to be localized for a long period of time. This has been
attributed to its homing phenomenon in which the neoplastic cell tends
to return to its original mucosal site rather than disseminate
elsewhere - Primary Gastric Lymphoma, moffitt.usf.edu
"Few
studies have investigated the relation between the location of MALT
lymphomas and their prognosis. In contrast to the results referred by
Thieblemont et al.,7 we found that the tendency to
progress or relapse seemed to be:
more
frequent in gastrointestinal than in non-gastrointestinal MALT
lymphomas (22% vs 10%).
The longer
time to progression showed by Thieblemont et al. for
gastrointestinal lymphomas has not been confirmed in our
study.
Although
our data showed no significant differences in either disease
free survival or overall survival between the two groups of
patients, the slight survival advantage for non-gastrointestinal
MALT lymphomas could be explained by their local involvement and
good performance status at diagnosis.
It is
possible that the single center nature of our study and the
inclusion of only patients with unequivocal histologic criteria of
MALT lymphoma, could have had some influence on the results." source:
haematologica
CD5+ as a marker of high-risk
disease? Perhaps, but beware of conclusions based on small
samples - just a few cases.
-
CD5+ Low-Grade Marginal Zone B-Cell Lymphomas With
Localized Presentation. ajsp.com
American Journal of Surgical Pathology.
22(2):201-207,
February 1998.
Ballesteros, Enrique M.D.; Osborne,
Barbara M. M.D.;
Matsushima, Anne Y. M.D.
Related Abstracts
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Assessment of Disease Dissemination in Gastric Compared With
Extragastric Mucosa-Associated Lymphoid Tissue Lymphoma Using
Extensive Staging: A Single-Center Experience.
J Clin Oncol. 2006 Jun 12;
PMID:
16769982 | Free
full text
Our findings suggest that MALT lymphoma
frequently presents as a multifocal disease. Extragastric MALT
lymphomas are significantly more prone to dissemination than
gastric MALT lymphomas."
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Predictive value of
endoscopic ultrasonography for regression of gastric low grade and
high grade MALT lymphomas after eradication of Helicobacter
pylori. Gut. 2001 Apr;48(4):454-60. PMID: 11247887 PubMed
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Immunological and molecular analysis of B lymphocytes in
low-grade MALT lymphoma of the stomach. Are there any useful
markers for predicting outcome after Helicobacter pylori
eradication? J Gastroenterol. 2002;37(6):428-33. PMID: 12108676
PubMed
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Comparative study of marginal zone lymphoma involving bone
marrow. Am J Clin Pathol. 2002 May;117(5):698-708. PMID: 12090417 PubMed
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Research News
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Research News
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Outcomes of Stage I/II Mucosa-Associated Lymphoid Tissue
Lymphoma Reported cancerconsultants.com
"These authors concluded that radiation therapy played
an important role in the curative therapy of MALT lymphoma.
However, since 90% received radiation therapy, it is difficult [or
impossible] to compare alternative therapies in this study.
Nevertheless, radiation therapy appears to be an effective
treatment for localized MALT lymphoma patients who have failed
antibiotic therapy."
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Update on MALT Lymphoma
Medscape
free login
Several interesting papers were presented concerning extranodal
marginal
zone MALT lymphomas. Approximately 75% of patients with
Helicobacter pylori
infection and localized MALT lymphoma of the stomach respond to
antibiotic therapy, experiencing eradication of the H pylori and the lymphoma
as well.
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Treatment of extranodal marginal zone B-cell lymphoma of
mucosa-associated lymphoid tissue type with cladribine: a phase II
study. J Clin Oncol. 2002 Sep 15;20(18):3872-7.
PMID: 12228207
PubMed
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IELSG phase II study of rituximab in MALT lymphoma: final
results Year: 2002 Abstract No: 1067
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Stage I and II MALT lymphoma: results of treatment with
radiotherapy. Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):1258-64. PMID:
11483337 PubMed
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Mucosa-associated
lymphoid tissue lymphoma with initial supradiaphragmatic
presentation: natural history and patterns of disease progression. Int J Radiat Oncol Biol Phys. 2000 Sep 1;48(2):399-403. PMID:
10974453 PubMed
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Molecular
follow-up in gastric mucosa-associated lymphoid tissue lymphomas:
early analysis of the LY03 cooperative trial.
Blood. 2002 Apr
1;99(7):2541-4. PMID: 11895791 PubMed
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Of interest to pts with MALT: Randomized trial of endoscopy with testing for Helicobacter pylori compared with non-invasive H pylori testing alone in the management of dyspepsia
BMJ 2002;324:999
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The Modified International Prognostic Index Can
Predict The Outcome Of Localized Primary Intestinal Lymphoma Of
Both Extranodal Marginal Zone B-Cell And Diffuse Large B-Cell
Histologies
International Extranodal Lymphoma Study Group (IELSG)
British Journal of Haematology, 2002, 118, 218–228 PDF
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NEW
Relapsed or refractory nongastric marginal zone B-cell lymphoma:
Multicenter retrospective analysis of 92 cases.
Am J Hematol. 2009. PubMed
- Related
Articles
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