High Relapse Rate in Patients with MALT Lymphoma Warrants Lifelong Follow-up

Abstract

Background: B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) is thought to be an indolent disease, with a good prognosis following various forms of treatment. Little, however, is known about the rate and pattern of relapse following successful treatment. Patients and Methods: We have analyzed time to and pattern of relapse in patients with MALT lymphoma, along with investigation of t(11;18)(q21;q21), t(1;14)(p22;q32), and t(14;18)(q32;q21) involving IGH/MALT1, trisomy 3, and trisomy 18. Eighty-six patients achieving complete remission (CR) after initial therapy with sufficient follow-up data were available. Primary site of disease was the stomach (n = 36), salivary gland (n = 19), ocular adnexa/orbit (n = 12), lung (n = 8), thyroid (n = 5), breast (n = 3), liver (n = 2), and skin (n = 1). Results: Thirty-two patients (37%) relapsed between 14 and 307 months (median 47 months) after initial CR. Ten relapses were local, whereas the remaining patients relapsed in a distant organ. Eight of 36 gastric versus 24 of 50 nongastric MALT lymphomas (P = 0.02) relapsed. Five patients had a second recurrence 26 to 56 months after a second CR. Relapse rates were not related to forms of initial treatment. Chromosomal aberrations were detected in 14 of 28 (50%) relapsing patients, and chromosomal alterations were identical at diagnosis and relapse. No significant association of any of the genetic changes investigated with relapse was found. Interestingly, patients with t(11;18)(q21;q21) had a significantly longer median time to relapse (76 months) than patients without this translocation (29 months; P = 0.012). Conclusions: In view of the late relapses seen in our series, lifelong observation of all patients treated for MALT lymphoma seems to be required.

Long‐term outcome in localized extranodal mucosa‐associated lymphoid tissue lymphomas treated with radiotherapy

“…This is in contrast to 1 study indicating that it is not uncommon to develop disease recurrence late in the course of followup. 27 Recurrences of disease typically behave in an indolent manner, and prolonged survival was observed even after disease recurrence (Fig. 3).…”

Non-Hodgkin's Lymphoma of Mucosa-Associated Lymphoid Tissue

“…When dissemination occurs, it is frequently to other mucosal sites. After therapy, relapse rates approached 40% in one retrospective analysis with a median follow-up of 47 months (range, 14-307 months); gastric MALT lymphomas were less likely to relapse than nongastric lesions (22% versus 48%) [22]. Rarely, the disease undergoes transformation to a more aggressive lymphoma type.…”

Linfoma do tecido linfóide associado ao brônquio com evolução fatal

“…(3) Despite their indolent behavior and excellent prognosis, MALT lymphomas do tend to relapse frequently. (13) In a study of pulmonary MALT lymphoma patients in long-term follow-up treatment, (11) it was reported that the overall survival of such patients was significantly worse than that observed in age-and gender-matched controls. Our report suggests that the disease progression is not always indolent.…”

“…The presence of the t(11;18)(q21;21) translocation, which is particularly prevalent in patients with gastric (23.9%) and pulmonary (53.3%) MALT lymphomas, (12) does not seem to be related to disease recurrence. (13) Nor is there any evidence that this translocation is associated with chemotherapy resistance.…”