About Lymphoma > Types of Lymphoma > Marginal Zone Lymphomas > MALT

Last update: 11/24/2009

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What is lymphoma?  
Briefly, lymphomas 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. 

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What is the 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) 

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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.

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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). 

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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. 

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Common initial diagnosis and approach

"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

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Staging

Staging refers to the how widespread the disease is. Imaging tests are used to estimate the stage:

  CT scans
  MR imaging
  PET scans, 
  Gallium scans, and 
  biopsies (bone marrow, endoscopy) 
        are commonly done to estimate the stage.

For MALT, use of gallium scans is common as this test can detect areas of inflammation and possible lymphoma. 

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Conditions Associated with MALT

TOPIC SEARCH: ASCO | Medscape | Web

 
"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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Monitoring MALT with PET?  

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Monitoring MALT with MRI?

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Recommended Resources for MALT

Other Resources

 
Extranodal MALT (non-gastric) based on areas of presentation

Resources based on areas of presentation

Also see 

Extra Nodal Lymphomas

OVERVIEW of non-gastric MALT

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BONE MARROW

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BREAST

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CUTANEOUS

"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

1. 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  
   

2. 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

3. 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.

4. 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.

5. 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.

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EYE

TOPIC SEARCH:  PubMed

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FORESKIN

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GASTRIC

"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

1. Fact file: Gastric MALT lymphoma, March 2005
    by Dr Andrew Wotherspoon  lymphoma.org.uk 
   
   Highly recommended synopsis 

2. Gastric MALT lymphoma: from aetiology to treatment.
   Lancet Oncol. 2002 Feb;3(2):97-104. Review. PMID: 11902529  PubMed

Musshoff - classification of gastrointestinal lymphomas

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HEPATIC (Liver)

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LUNG - BRONCHUS-ASSOCIATED (BALT)

Related PubMed Articles  PubMed

Related PubMed Articles  PubMed

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NODAL ORIGIN

See Marginal Zone Lymphoma - Nodal

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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

1. About Parotid Tumors emedicine.com

2. Diagnosis and Treatment of Malignant Lymphoma of the Parotid Gland  jjco.oxfordjournals.org

 Abstracts

1. MALT lymphoma presenting as a cystic salivary gland mass.
   Head Neck. 2001 Mar;23(3):254-8. PMID: 11428457

2. 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

3. 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

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) 

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TOPIC SEARCH:
All: ASCO | Medscape | Web 
Antibiotics AND MALT: ASCO | Medscape | Web
Rituxan AND MALT:  ASCO | Medscape | Web 

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Treatment Guidelines

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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. 

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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

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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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First line Rituxan for MALT?

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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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Treatment resources and reports

Clinical Trials

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ClinicalTrials.gov searches by

Prognosis

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"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:

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Related Abstracts

Research News

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