How Gastric MALT Lymphoma is Treated

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.

Woman with upset stomach clutching her abdomen
Creative RM / BSIP  /UIG / Getty Images

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

For H. 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 antibody called 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.

18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Violeta Filip P, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Department of Internal Medicine II and Gastroenterology, Emergency University Hospital, Bucharest, et al. MALT lymphoma: epidemiology, clinical diagnosis and treatment. JMedLife. 2018;11(3):187-193. doi: 10.25122/jml-2018-0035

  2. Safavi M, Sabourian R, Foroumadi A. Treatment of Helicobacter pylori infection: Current and future insights. World Journal of Clinical Cases. 2016;4(1):5-19. doi: doi.org/10.25122/jml-2018-0035

  3. Nam TK, Ahn JS, Choi YD, et al. The role of radiotherapy in the treatment of gastric mucosa-associated lymphoid tissue lymphoma. Cancer Res Treat. 2014;46(1):33-40. doi: 10.4143/crt.2014.46.1.33

  4. Alsolaiman MM, Bakis G, Nazeer T, MacDermott RP, Balint JA. Five years of complete remission of gastric diffuse large B cell lymphoma after eradication of Helicobacter pylori infection. Gut. 2003;52(4):507-509. doi: 10.1136/gut.52.4.507

  5. Rohm CL, Acree S. Gastric MALT lymphoma refractory to Helicobacter pylori antibiotic therapy. SAGE Open Medical Case Reports. 2019;7:2050313X1986947. doi: 10.1177/2050313X19869473

  6. Song M. Second and third line treatment options for Helicobacter pylori eradication. WJG. 2014;20(6):1517. doi:10.1177/2050313X19869473

  7. Kim JS, Kang SH, Moon HS, Sung JK, Jeong HY. Clinical outcome of eradication therapy for gastric mucosa-associated lymphoid tissue lymphoma according to h. Pylori infection status. Gastroenterology Research and Practice. 2016;2016:1-7. doi: 10.1155/2016/6794848

  8. Lim HW, Kim TH, Choi IJ, et al. Radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma: dose-volumetric analysis and its clinical implications. Radiat Oncol J. 2016;34(3):193-201. doi: 10.3857/roj.2016.01865

  9. Shimohigashi Y, Toya R, Saito T, et al. Impact of four-dimensional cone-beam computed tomography on target localization for gastric mucosa-associated lymphoid tissue lymphoma radiotherapy: reducing planning target volume. Radiat Oncol. 2021;16(1):14. doi: 10.1186/s13014-020-01734-w

  10. Juárez-Salcedo LM, Sokol L, Chavez JC, Dalia S. Primary gastric lymphoma, epidemiology, clinical diagnosis, and treatment. Cancer Control. 2018;25(1):107327481877825. doi: 10.1177/1073274818778256

  11. Škubník J, Pavlíčková VS, Ruml T, Rimpelová S. Vincristine in combination therapy of cancer: emerging trends in clinics. Biology. 2021;10(9):849. doi: https://doi.org/10.3390/biology10090849

  12. Sato Y, Kondo M, Inagaki A, et al. Highly frequent and enhanced injection site reaction induced by peripheral venous injection of fosaprepitant in anthracycline-treated patients. J Cancer. 2014;5(5):390-397. doi: 10.7150/jca.7706

  13. Ikeda T, Fujiwara S ichiro, Nakajima Hi, et al. Impact of prednisolone dosage in the CHOP regimen for follicular lymphoma: a retrospective study. Int J Hematol. 2020;112(3):369-376. doi: 10.1007/s12185-020-02908-8

  14. Shah H, Stephens D, Seymour J, Maddocks K. Incorporating novel targeted and immunotherapeutic agents in the treatment of b-cell lymphomas. American Society of Clinical Oncology Educational Book. 2021;(41):310-327. doi: 10.1007/s12185-020-02908-8

  15. Annibali O, Chiodi F, Sarlo C, et al. Rituximab as single agent in primary malt lymphoma of the ocular adnexa. BioMed Research International. 2015;2015:e895105. doi: 10.1155/2015/895105

  16. Pierpont TM, Limper CB, Richards KL. Past, present, and future of rituximab—the world’s first oncology monoclonal antibody therapy. Front Oncol. 2018;8:163. doi: 10.3389/fonc.2018.00163

  17. Saulite I, Guenova E, Hoetzenecker W. Adverse reactions of antibody-therapy for primary cutaneous lymphomas: rituximab, brentuximab vedotin, alemtuzumab, and mogamulizumab. In: Puig L, Gulliver W, eds. Current Problems in Dermatology. Vol 53. S. Karger AG; 2018:70-81. doi: 10.1159/000478079

  18. Juárez-Salcedo LM, Sokol L, Chavez JC, Dalia S. Primary gastric lymphoma, epidemiology, clinical diagnosis, and treatment. Cancer Control. 2018;25(1):107327481877825. doi: 10.1177/1073274818778256

Additional Reading

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