How I treat MALT lymphoma: 'a subjective interpretation of the gospel according to Isaacson….'
Markus RadererBarbara KiesewetterPublished in: ESMO open (2021)
Mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) is an indolent B-cell lymphoma characterised by a fascinating interplay between chronic antigenic stimulation, an immune response insufficient for elimination of the antigen and a mucosal 'battleground'. The archetype of this association is infection of the gastric mucosa with Helicobacter pylori (HP): a single course of antibiotic HP-eradication treatment may result in long-term remission in up to 80% of patients and is the gold standard for first-line therapy of HP-associated gastric MALT lymphoma. In extragastric or disseminated disease, treatment options range from wait and see in asymptomatic individuals to radiotherapy in localised stages, anti-CD20-antibodies in patients with low symptomatic burden and chemotherapy-based treatment or radio-immunotherapy in symptomatic disease. In addition, more refined immunomodulatory strategies beyond simple eradication of bacteria such as long-term use of the macrolide clarithromycin or the immunomodulatory drug lenalidomide are active. In view of the indolent clinical course, the least toxic individual treatment should be chosen in a disease usually not influencing overall survival in affected patients.
Keyphrases
- helicobacter pylori
- end stage renal disease
- diffuse large b cell lymphoma
- helicobacter pylori infection
- newly diagnosed
- immune response
- chronic kidney disease
- ejection fraction
- peritoneal dialysis
- early stage
- squamous cell carcinoma
- prognostic factors
- radiation therapy
- combination therapy
- low dose
- stem cells
- locally advanced
- radiation induced
- rheumatoid arthritis
- emergency department
- hodgkin lymphoma
- ulcerative colitis
- smoking cessation
- stem cell transplantation
- chemotherapy induced