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Gastric MALT lymphoma is grown by a stomach bacterium, and killing the bacterium with a ten to fourteen day course of antibiotics cures most cases. It is the only common cancer whose first-line treatment is an antibiotic.
The observation was published in 1993: in six patients with low-grade gastric MALT lymphoma, eradicating Helicobacter pylori made the lymphoma regress in five. The mechanism is that the lymphoma depends on antigen-driven stimulation by the organism, so removing the stimulus removes the driver, at least until the clone acquires a translocation that frees it.
What is given. A standard eradication regimen chosen by local antibiotic resistance: a proton pump inhibitor with clarithromycin and amoxicillin or metronidazole for 10 to 14 days, or a bismuth-containing quadruple regimen where clarithromycin resistance is high. The regimen is the same one used for peptic ulcer disease; there is no oncological version of it.
What has to be checked afterwards. Eradication must be confirmed, by urea breath test or stool antigen at least four weeks after the antibiotics and two weeks after stopping the proton pump inhibitor, because incomplete eradication is the commonest reason for the lymphoma not to respond and it is easily missed. Endoscopy with biopsies is repeated every three to six months. Regression is slow: histological disappearance can take twelve to eighteen months, and persistent minimal histological disease in an asymptomatic patient with successful eradication is watched rather than treated.
What predicts failure. The t(11;18)(q21;q21) translocation, which produces an API2-MALT1 fusion, makes the lymphoma independent of the bacterium and predicts failure of eradication; testing for it identifies patients who will need radiotherapy or systemic treatment sooner. Deep invasion beyond the submucosa, nodal involvement and a Helicobacter-negative tumour also predict failure, although eradication therapy is still given to many Helicobacter-negative cases because a proportion respond.
Related infections at other MALT sites are treated on the same reasoning with far weaker evidence: doxycycline for Chlamydia psittaci in ocular adnexal MALT, antibiotics for Borrelia burgdorferi in cutaneous MALT, and for Campylobacter jejuni in immunoproliferative small intestinal disease.
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: Splenic marginal zone lymphoma, Nodal marginal zone lymphoma, Primary cutaneous marginal zone lymphoma, Primary cutaneous follicle centre lymphoma, Sezary syndrome, Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma), Hepatosplenic T-cell lymphoma, Intravascular large B-cell lymphoma, Lymphomatoid granulomatosis, T-cell prolymphocytic leukaemia, Splenic B-cell lymphoma/leukaemia with prominent nucleoli (formerly B-cell prolymphocytic leukaemia and hairy cell leukaemia variant), T-cell large granular lymphocytic leukaemia, Mixed-phenotype acute leukaemia, Myeloid leukaemia of Down syndrome, Burkitt leukaemia, Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Non-Hodgkin lymphoma (all types), Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, chronic phase, Chronic myeloid leukaemia, accelerated and blast phase, Primary myelofibrosis, Standard-risk B-cell acute lymphoblastic leukaemia in children, High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL), Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year), Relapsed and refractory acute lymphoblastic leukaemia in children, Acute myeloid leukaemia in children, Erdheim-Chester disease, Rosai-Dorfman-Destombes disease, Single-system Langerhans cell histiocytosis (bone, skin or one other organ), Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement), Indolent and smouldering systemic mastocytosis, Advanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia), Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), Relapsed and refractory classical Hodgkin lymphoma
Showing the organ this term concerns: Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma).
The site-specific and stage-specific approach on the marginal zone lymphoma page follows this guideline.
Antibiotic eradication is the first-line treatment for Helicobacter pylori-positive gastric MALT lymphoma, curing most patients without chemotherapy or radiotherapy.
Shares Marginal zone lymphomas: ESMO clinical practice guidelines, Watch and wait in lymphoma: when the right treatment is none yet, Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Marginal zone lymphoma.
Shares Watch and wait in lymphoma: when the right treatment is none yet, Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy, Marginal zone lymphoma.
Shares Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy, Marginal zone lymphoma.
Shares Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Marginal zone lymphoma.
Shares Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Marginal zone lymphoma.
Shares Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Marginal zone lymphoma.
Shares Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Marginal zone lymphoma.
Shares Endoscopy (EGD, EUS, ERCP), Gastric & gastro-oesophageal junction cancer.