Table 1: Summary of most recommended treatments options in GI tract MALT lymphomas.
|
Location |
Frequency |
HP infection |
Treatment |
Comments |
|
Esophagus |
< 1% |
NEA
|
≥ 3 cm: SR < 3cm: ER |
Usually Cht or Rt is added [8] |
|
Stomach |
60% |
EI
EI/NI NI
|
L: HPE. If relapse or not respond: Rt (best results) [4] [9] +/- Cht +/- Sg
D: Cht based on R L and low grade: Rt (the best results) |
Ab regimen should be based on epidemiology and resistances. t(11;18)/API2-MALT1 is associated with resistance to Ab.[10] No agreement about Rt in these cases Usually 30-40 Gy [9] Cht in study, at this date, best results with R + Bd/Cl/ Fl |
|
Small bowel |
30% |
Campylobacter jejuni EI
NI
|
Ab régimen [11]
L: SR/ER Rt D: Cht based on R or Cl
|
Tetracycline or metronidazole and ampicillin at least 6 months
FLT
Usually R-CHOP In study: R + Cl/Fl |
|
Large bowel - Cecum and rectum
- Sigmoid colon
|
2.5% |
NEA
NEA
|
L: SR/ER D: Cht based on R Rt good responses
L: SR/ER D: Cht based on R
|
Some cases responses at HPE (even negative). One case published of relapse after 1 year who received levofloxacin 14 days.
FLT [4] Rt before resection to dismal the lesion is also an option Usually R-CHOP +/- Rt [4] R in monotherapy is being studied [4] |
NEA: No Evidence of Association; EI: Evidence of Infection; NI: No Evidence of Infection; L: Localized; D: Disseminated; SR: Surgical Resection; ER: Endoscopic Resection S; Cht: Chemotherapy; Rt: Radiotherapy; Sg: Surgery; HP: Helycobacter pylori; HPE: HP Eradication; Ab: Antibiotics; FLT: First Line Treatment; HPE: Helicobacter pylori Eradication; R- CHOP: Rituximab Cyclophosphamide Hydroxydaunomycin Oncovin Prednisolone; R: Rituximab; Cl: Clorambucil; Bd: Bendamustine; Fl: Fludarabine.