MALT-lymphoma of the stomach: clinical presentation, diagnostics and treatment
Abstract
The aim of review. To present up-to-date data on diagnostics and treatment of MALT-lymphoma of the stomach and experience of N.N.Burdenko Chief military clinical hospital in treatment of patients with this disease.
Original positions. Not so long ago mucosa-associated lymphoid tumor was included in WHO classification of hemopoietic and lymphoid tissues tumors, which is terminologically determined as extranodal marginal zone В-cellular lymphoma of the MALT-type. It is proved, that approximately 90% of cases of stomach МАLT-lymphomas are related to H. pylori infection. Despite the extensive data obtained for the last two decades on clinical and pathomorphologic properties of this disease, its molecular genetic features, optimal medical approach for this nosological entity it is not developed yet. It is especially actual for regional stages of disease. The article stresses therapeutic aspects: correspondence of treatment approach to disease stage, presence of Н. pylori infection, role of eradication and radiation therapy, surgery and chemotherapy. Basing on obtained data, original treatment algorithm was developed, which is proposed to application in clinical practice to provide optimal amount of medical care to the patient.
Conclusion. Findings in MALT-lymphoma biology allowed to introduce new scientific and practical treatment projects in practice.
About the Authors
Ye. V. Ledin
ФГУ «Главный военный клинический госпиталь им. Н.Н. Бурденко Минобороны России»
Russian Federation
Russian Federation
A. P. Seryakov
ФГУ «Главный военный клинический госпиталь им. Н.Н. Бурденко Минобороны России»
Russian Federation
Russian Federation
V. L. Astashov
ФГУ «Главный военный клинический госпиталь им. Н.Н. Бурденко Минобороны России»
Russian Federation
Russian Federation
References
1. Гематология / Под ред. О.А. Рукавицына. – СПб: ООО «Д.П.», 2007. – 912 с.
2. Akamatsu T., Mochizuki T., Okiyama Y. et al. Comparison of localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma with and without Helicobacter pylori infection // Helicobacter. – 2006. – P. 11:86–95.
3. Bacon C., Ming-Qing Du, Dogan A. Mucosa-associated lymphoid tissue (MALT) lymphoma: a practical guide for pathologists // J. Clin. Pathol. – 2007. – Vol. 60. – P. 361–372.
4. Bertoni F., Zucca E. State-of-the-art therapeutics: Marginal-zone lymphoma // J. Clin. Oncol. – 2005. – Vol. 23. – P. 6415–6420.
5. Brands F., Monig S.P., Raab M. Treatment and prognosis of gastric lymphoma // Eur. J. Surg. – 1997. – Vol. 163. – P. 803–813.
6. Chaudhary N., Ozer H., Huard D. et al. Successful treatment of Helicobacter pylori-negative gastric MALT lymphoma with rituximab // Dig. Dis. Sci. – 2006. – Vol. 51. – P. 775–778.
7. Chung S.J., Kim J.S., Kim H. et al. Long-term clinical outcome of Helicobacter pylori-negative gastric mucosaassociated lymphoid tissue lymphoma is comparable to that of h. pylori-positive lymphoma // J. Clin. Gastroenterol. – 2009. – Vol. 43. – P. 312–317.
8. Cohen S., Petryk M., Varma M. Non-Hodgkin’s lymphoma of mucosa-associated lymphoid tissue // The Oncologist. – 2006. – Vol. 11. – P. 1100–1117.
9. De Vita V., Hellman S., Rosenberg S. Cancer. Principles and practice of oncology. – 2008. – P. 2098–2143.
10. Farinha P., Gascoyne R. Molecular pathogenesis of mucosa-associated lymphoid tissue lymphoma // J. Clin. Oncol. – 2005. – Vol. 23. – P. 6370–6378.
11. Hoffmann M., Kletter K., Becherer A. et al. 18F-fluorodeoxyglucose positron emission tomography (18F-FDGPET) for staging and follow-up of marginal zone B-cell lymphoma // Oncology. – 2003. – Vol. 64. – P. 336– 340.
12. Hyung Soon Park, Yu Jin Kim, Woo Ick Yang et al. Treatment outcome of localized Helicobacter pylorinegative low-grade gastric MALT lymphoma // World J. Gastroenterol. – 2010. – Vol. 16, N 17. – P. 2158– 2162.
13. Isaacson P., Wright D. Malignant lymphoma of mucosaassociated lymphoid tissue: a distinctive type of B-cell lymphoma // Cancer. – 1983. – Vol. 52. – P. 1410– 1416.
14. Jaffe E., Harris N., Stein H. et al. World Health Organisation classification of tumours: Pathology and genetics of tumours of haematopoietic and lymphoid tissues. – Lyon: IARC Press, 2001. – P. 157–160, 351.
15. Koch P., Probst A., Berdel E. et al. Treatment results in localized primary gastric lymphoma: data of patients registered within the German multicenter study (GIT NHL 02/96) // J. Clin. Oncol. – 2005. – Vol. 23. – P. 7050–7059.
16. Levy M., Copie-Bergman C., Gameiro C. et al. Prognostic value of translocation t(11;18) in tumoral response of low-grade gastric lymphoma of mucosaassociated lymphoid tissue type to oral chemotherapy // J. Clin. Oncol. – 2005. – Vol. 23. – P. 5061–5066.
17. Martinelli G., Laszlo D., Ferreri A. et al. Clinical activity of rituximab in gastric marginal zone nonHodgkin’s lymphoma resistant to or not eligible for anti-Helicobacter pylori therapy // J. Clin. Oncol. – 2005. – Vol. 23. – P. 1979–1983.
18. Ming-Quing Du. MALT lymphoma: recent advances in aetiology and molecular genetics // J. Clin. Exp. Hematopathol. – 2007. – Vol. 47. – P. 31–42.
19. Morgner A., Schmelz R., Christian Thiede C. et al. Therapy of gastric mucosa associated lymphoid tissue lymphoma // World J. Gastroenterol. – 2007. – Vol. 13, N 26. – P. 3554–3566.
20. Nakamura S., Matsumoto T., Ye H. et al. Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: a clinicopathologic and molecular study with reference to antibiotic treatment // Cancer. – 2006. – Vol. 107. – P. 2770–2778.
21. Nakamura T., Seto M., Tajika M. et al. Clinical features and prognosis of gastric MALT lymphoma with special reference to responsiveness to H. pylori eradication and API2-MALT1 status // Am. J. Gastroenterol. – 2008. – Vol. 103. – P. 62–70.
22. Psyrril A., Papageorgiou S., Economopoulos T. Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management // Ann. Oncol. – 2008. – Vol. 19. – P. 1992–1999.
23. Raderer M., Streubel B., Wöhrer S. et al. Successful antibiotic treatment of Helicobacter pylori negative gastric mucosa associated lymphoid tissue lymphomas // Gut. – 2006. – Vol. 55. – P. 616–618.
24. Rohatiner A., d’Amore F., Coiffier B. et al. Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma // Ann. Oncol. – 1994. – Vol. 5. – P. 397–400.
25. Ruskone-Fourmestraux A., Lavergne A., Aegerter P.H. et al. Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment // Gut. – 2001. – Vol. 48. – P. 297–303.
26. Schechter N., Portlock C., Yahalom J. Treatment of mucosaassociated lymphoid tissue lymphoma of the stomach with radiation alone // J. Clin. Oncol. – 1998. – Vol. 16. – P. 1916–1921.
27. Schmelz R., Thiede C., Dragosics B. et al. HELYX Study Part I & II: Treatment of lowgrade gastric nonHodgkin‘s lymphoma of mucosa-associated lymphoid tissue (MALT) type stages I & II1, an interim analysis // Gastroenterology. – 2005. – Vol. 128. – P. 295 (Abstract).
28. Stathis A., Chini C., Bertoni F. et al. Longterm outcome following Helicobacter pylori eradication in a retrospective study of 105 patients with localized gastric marginal zone B-cell lymphoma of MALT type // Ann. Oncol. – 2009. – Vol. 20. – P. 1086–1093.
29. Steinbach G., Ford R., Glober G. et al. Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue. An uncontrolled trial // Ann. Intern. Med. – 1999. – Vol. 131. – P. 88–95.
30. Suzuki Н., Saito Y., Hibi T. Helicobacter pylori and gastric Mucosa-associated Lymphoid Tissue (MALT) Lymphoma: Updated review of clinical outcomes and the molecular pathogenesis // Gut and Liver. – 2009. – Vol. 3, N 2. – P. 81–87.
31. Taal B., Boot H., van Heerde P. et al. Primary non-Hodgkin lymphoma of the stomach: endoscopic pattern ad prognosis in low versus high grade malignancy in relation to the MALT concept // Gut. – 1996. – Vol. 39. – P. 556–561.
32. Terai S., Iijima K., Kato K. et al. Long-term outcomes of gastric mucosa-associated lymphoid tissue lymphomas after Helicobacter pylori eradication therapy // Tohoku J. Exp. Med. – 2008. – Vol. 214. – P. 79–87.
33. Tsang R.W., Gospodarowicz M.K., Pintilie M. et al. Localized mucosaassociated lymphoid tissue lymphoma treated with radiation therapy has excellent clinical outcome // J. Clin. Oncol. – 2003. – Vol. 21. – P. 4157–4164.
34. Wotherspoon A., Doglioni C., Diss T. et al. Regression of primary low-grade B-cell gastric lymphoma of mucosaassociated lymphoid tissue type after eradication of Helicobacter pylori // Lancet. – 1993. – Vol. 342. – P. 575–577.
35. Wündisch T., Mosch C., Neubauer A., Stolte M. Helicobacter pylori eradication in gastric mucosaassociated lymphoid tissue lymphoma: Results of a 196patient series // Leuk Lymphoma. – 2006. – Vol. 47. – P. 2110–2114.
36. Wündisch T., Thiede C., Morgner A. et al. Long-term follow-up of gastric MALT lymphoma after Helicobacter pylori eradication // J. Clin. Oncol. – 2005. – Vol. 23. – P. 8018–8024.
37. Ye H., Liu H., Raderer M. et al. High incidence of t(11;18)(q21;q21) in Helicobacter pylori-negative gastric MALT lymphoma // Blood. – 2003. – Vol. 101. – P. 2547–2550.
38. Zucca E., Dreyling M. Gastric marginal zone lymphoma of MALT type: ESMO clinical practice guidelines for diagnosis, treatment and follow-up // Ann. Oncol. – 2010. – Vol. 21. – P. 175–176.
Review
For citations:
Ledin Ye.V., Seryakov A.P., Astashov V.L. MALT-lymphoma of the stomach: clinical presentation, diagnostics and treatment. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2011;21(1):69-78. (In Russ.)
Views:
67
Email this article 
