What Are the Treatments for Gastric MALT Lymphoma? (2023)

Gastric (MALT) lymphoma is a form of non-Hodgkin lymphoma that arises from tissue that forms the lining of the stomach, the mucosa-associated lymphoid tissue (MALT). Because gastric MALT lymphoma usually is caused by Helicobacter pylori(H. pylori) bacteria, it often can be treated successfully with antibiotics.

For the minority of cases that are not associated with H. pylori infection, or those that do not respond to antibiotics, other treatment options include radiation, chemotherapy, and surgery.What's more, because gastric MALT lymphoma is such a slow-growing cancer, many people with the disease are able to forgo treatment altogether and can instead be monitored closely by their doctor.

Active Monitoring

If patients are H Pylori positive, they are always treated with antibiotics to eradicate the H Pylori infection, which can often lead to regression of the lymphoma.

If patients are H Pylori negative, or if eradication of H Pylori does not lead to regression of the lymphoma, but the lymphoma is localized to the stomach, radiation therapy is usually used.

For people with gastric MALT lymphoma whose disease is not widespread and who do not have symptoms, active monitoring, also called watch-and-wait, might be an option.

Active monitoring entails close surveillance of a disease or condition to see if it will resolve or stabilize without treatment. Doing so can be an effective way to avoid the potential side effects of treatment. For gastric MALT lymphoma, active monitoring typically involves regular endoscopies, physical exams, and lab tests.

Triple Therapy

ForH. pylori-positive gastric MALT lymphoma, the first-line treatment is a protocol called triple therapy, which involves a combination of two antibiotics to fight the infection plus a proton pump inhibitor (PPI) drug to lower the production of gastric acid in the stomach and prevent ulcers.

The antibiotics used most often are Amoxil (amoxicillin), Biaxin (clarithromycin), Sumycin (tetracycline), and Flagyl (metronidazole).

Although it may take several months for this treatment to work, this regimen is effective in about 90% of gastric MALT lymphoma cases.

Radiation

For cases of MALT lymphoma not caused by H.pylori infection or for those that don't respond to antibiotics, radiation therapy can be an effective option.

This protocol involves directing relatively low doses of external beam radiation to the tumors in the stomach. Studies show radiotherapy of gastric (MALT) lymphoma provides excellent long-term local control and survival.

Chemotherapy

Chemotherapy is used for early-stage gastric MALT lymphomas when antibiotics fail to control the disease, or when the lymphoma recurs after a period of remission.

The chemo drugs often used are a combination of four different medications that together are known by the acronym CHOP: Cytoxan (cyclophosphamide), Adriamycin (doxorubicin), Oncovin (vincristine), and prednisone. The first three of these drugs combat cancer cells in different ways and are usually are given as injections or infusions of veins on a single day.

Prednisone is a steroid that is taken in pill form for five days.

Kinase Inhibitors

Kinase inhibitors are drugs that target lymphoma cells and block kinases—proteins that cause cancer cells to grow and flourish. Two kinase inhibitors used to treat MALT non-Hodgkin lymphoma are Imbruvica (ibrutinib) and Calquence (acalabrutinib). These drugs are taken twice a day by mouth.

Monoclonal Therapy

MALT lymphoma can be treated with a monoclonal antibodycalled Rituxan (rituximab).

Rituxan targets CD20, an antigen that's associated with gastric MALT lymphoma. (Antigens are molecules that trigger the immune response.) It's given intravenously (IV) or as an injection under the skin, and it can be used alone or in combination with chemotherapy drugs.

Two other drugs sometimes used for MALT lymphoma are Adcetris (brentuximab vedotin) and Campath (alemtuzumab).

Surgery

A gastrectomy surgery can be used to treat gastric MALT lymphoma. This procedure involves removing a portion of or all of the stomach (partial gastrectomy and total gastrectomy, respectively).

Gastrectomy is rarely if ever a first-line treatment for MALT lymphoma, given the inherent risks of surgery and the fact that the disease usually can be treated without surgery. However, it may be recommended in cases in which the lymphoma is limited to a distinct area and can be safely and easily removed.

A Word From Verywell

Learning that you or someone you care for has cancer is undoubtedly scary, even when the diagnosis is a slow-growing and easily treated disease such as gastric MALT lymphoma.

Your treatment plan can include approaches like periodic tests for active monitoring of your disease or taking medications, such as antibiotics. Learning all you can about MALT lymphoma should help to alleviate many of your concerns.

By Indranil Mallick, MD
Indranil Mallick, MD, DNB, is a radiation oncologist with a special interest in lymphoma.