Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of the Stomach: Results of a Controlled Clinical Trial

Abstract

Treatment of patients with early stage gastric mucosa-associated lymphoid tissue (MALT) remains undefined. We began a controlled clinical trial to evaluate efficacy and toxicity of the most common therapies. Two hundred and forty-one patients with gastric low-grade MALT lymphoma in early stage (IE and IIE) were randomized to surgery (80 cases), radiotherapy (78 cases), and chemotherapy (83 cases). With a median follow-up of 7.5 yr, actuarial curves at 10 yr showed that event-free survival was 52% in patients treated with surgery, 52% in radiotherapy arm, and 87% in the chemotherapy group (p < 0.01). However, overall survival did not showed any statistical differences: 80%, 75% and 87%, respectively (p = 0.4). Acute and late toxicities were mild. No death-related treatments were observed. No clear differences were observed between the most common therapies in patients with primary gastric MALT lymphoma in early stages, probably because this type of lymphoma has an high response rate to salvage treatment after failure to local treatment (surgery and radiotherapy). Thus considered, chemotherapy alone is an effective and safe therapeutic approach in this setting of patients. Surgery or radiotherapy will be reserved to patients that are not candidates for chemotherapy.

A phase II study of bortezomib in patients with MALT lymphoma

“…[2][3][4] In patients with a priori disseminated/extragastric disease or refractory to HP-eradication, systemic treatment approaches are being explored due to promising results obtained with phase II studies [5][6][7][8] and one controlled trial. 9 In the latter, a significantly superior event free survival at ten years was noted with application of CHOP/CVP chemotherapy as compared to surgery and radiation. In view of the scarce data, however, no standard regimen for systemic therapy of MALT lymphoma has emerged, warranting further studies of novel agents with a potentially favorable toxicity profile.…”

Management of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

“…However, from this retrospective analysis, a potential selection bias cannot be excluded, as historically chemotherapy has mostly been given to patients with worse prognostic factors. In keeping with this notion, a prospective study by Avilés et al [44] showed that chemotherapy resulted in a significantly better event-free survival at 10 years compared to radiation and surgery, with 85 patients included in each treatment arm. MALT lymphomas are highly susceptible to radiation.…”

Therapy of gastric mucosa associated lymphoid tissue lymphoma

“…In a recent, again nonrandomized multicenter trial, these results were confirmed in almost 750 patients [48] . In addition, two randomized studies by Avilés et al [79,80] further supported that surgery could be omitted from primary treatment of early gastric lymphoma. Most contemporary treatment algorithms no longer include surgical resection in the primary treatment of gastric lymphoma and reserve surgery for the management of complications or unique cases of locally persistent disease.…”