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Key points for the diagnosis and treatment of gastric mucosa-associated lymphoid tissue lymphoma: 3 minutes speed reading

 Last Update: 2023-01-06
 Source: Internet
 Author: User

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Mucosa-associated tissue lymphoma (MALT) is called extranodal mucosa-associated lymphoid tissue marginal zone B-cell lymphoma, which is a kind of marginal zone lymphoma (MZL), accounting for about 7%~8%
of newly diagnosed non-Hodgkin lymphoma (NHL).

MALT lymphoma is divided into gastric MALT and non-gastric MALT lymphoma
.
The biological behavior of gastric MALT lymphoma is usually inert, with a good prognosis, and the 10-year overall survival rate of patients can reach 90%, but some patients have rapid progression, short-term recurrence, and treatment resistance
.
This article will sort
out the key points of diagnosis and treatment of gastric MALT lymphoma.

The etiology and pathogenesis
are normal: The gastric mucosa does not contain lymphoid tissue, and most gastric MALT lymphoma originates from mucosal lymphoid tissue acquired after Helicobacter pylori (Hp) infection, often presenting as an indolent clinical process
.

Hp long-term antigen stimulation causes lymphoid tissue associated with mucosal epithelium to produce immune response and local inflammation, immunoreactive lymphatic proliferation, host local immune response under certain infections, T cells and macrophages in the mucosa produce various cytokines, which stimulate B cell proliferation and form lymphatic follicles
.
In gastric MALT lymphoma, the Hp detection rate is as high as 90%.

Numerous studies have shown that persistent Helicobacter pylori infection plays a role
in the development of gastric mucosa-associated lymphoid tissue lymphoma.

Diagnostic methods
Endoscopic biopsy is required for the diagnosis of gastric MALT lymphoma, and immunohistochemistry, polymerase chain reaction (PCR) analysis, fluorescence in situ hybridization (FISH) detection t (11; 18) and other laboratory tests
.

Staging of gastric MALT lymphoma

Source: Reference 1

treat

Eradication of Hp treatment

The Sixth National Consensus Report on the Treatment of Helicobacter Pylori Infection pointed out that eradication of Hp is the first-line treatment
for locally staged gastric MALT lymphoma.
(Evidence level: A; Recommended strength: strong; Consensus level: 100%.

For Hp-positive local stage (Lugano stage I/II) gastric MALT lymphoma, 60%~80% of patients can achieve remission
after eradication of Hp.
Hp eradication therapy is ineffective for most gastric MALT lymphomas with t(11,18) translocation, which require chemotherapy and/or radiation therapy
.
Two newly published meta-analyses showed that some patients with Hp-negative gastric MALT lymphoma could also achieve disease remission
with Hp eradication therapy.

Radiotherapy

MALT lymphoma is sensitive
to radiation therapy.
Studies have shown that when anti-Hp therapy fails for early MALT lymphoma and gastric MALT lymphoma, the complete response rate of moderate to low-dose radiotherapy alone is more than 95%, and the 5-year overall survival (OS) is more than
90%.
At present, radiotherapy is considered to be the main treatment
for early non-gastric MALT lymphoma, Hp-negative and anti-Hp failed gastric MALT lymphoma.

Chemotherapy, targeted therapy

Chemotherapy has traditionally used CHOP regimens, i.
e.
, cyclophosphamide, doxorubicin (doxorubicin), vincristine, and prednisone (prednisone), and CHOP is now advocated as the first-line treatment for
high malignant lymphoma.

In recent years, some research data related to the treatment of gastric MALT lymphoma have also been published, and this field still needs to be explored
.

At present, chemotherapy and targeted therapy cannot be used as the first treatment
for early-stage MALT lymphoma and gastric MALT lymphoma with anti-Hp failure.

References: 1.
LIU Ke, ZHU Suyu.
Progress in clinical treatment of mucosa-associated lymphoid tissue lymphoma [J] .
Chinese Journal of Radiation Oncology, 2017, 26 (08): 956-960 2.
JIANG Chong, SUN Yiwen, TENG Yue, et al.
Gastric mucosa-associated lymphoid tissue ^{lymphoma 18}F-FDG PET/CT imaging and digestive endoscopy controlled study [J] .
Chinese Journal of Nuclear Medicine and Molecular Imaging, 2021, 41(11): 660-663 3.
NCCN Clinical Practice Guidelines in Oncology:B-Cell Lymphomas (Version 5.
2022) 4.
ZHU Yueyong,ZHUANG Zehao,DONG Jing.
Gastroenterologist Ward Rounds Manual (2nd Edition)[M].
Beijing:Chemical Industry Press,2017,45-49.
5.
Helicobacter pylori group, Gastroenterology Branch of Chinese Medical Association.
The Sixth National Consensus Report on the Management of Helicobacter Pylori Infection (Non-Eradication Therapy Part) [J] .
Chinese Journal of Digestion, 2022, 42(5): 289-303

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