Review
How I treat MALT lymphoma: ‘a subjective interpretation of the gospel according to Isaacson….’

https://doi.org/10.1136/esmoopen-2020-000812Get rights and content
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ABSTRACT

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.

MALT lymphoma
extranodal lymphoma
Helicobacter pylori
antibiotics
chemotherapy

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Contributors: Concept, writing and final approval of the manuscript: MR and BK.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: MR declares honoraria for lectures from Novartis, Ipsen, Eisai and Celgene; BK declares honoraria for lectures from Novartis, Ipsen and Celgene.

Patient consent for publication: Not required.

Provenance and peer review: Commissioned; externally peer reviewed.