MALT LYMPHOMA

 The stomach is the site of more than half of gastrointestinal

lymphomas and is the most common organ involved in
extranodal lymphomas.

 The gastric submucosa does not ordinarily contain lymphoid

tissue, and the development of lymphoid tissue resembling small
intestinal Peyer's patches is believed to occur in response to
infection with H. pylori.

 A number of observations support a causal relationship between

chronic H. pylori infection and lymphoma development. H. pylori
is present in the stomachs of more than half of patients with
gastric lymphoma.

 Low-grade lymphoma is postulated to occur as a result of

monoclonal B-cell proliferation.

 B-cell proliferation depends on interleukin-2 production by

antigenically stimulated nonneoplastic T cells.

 Complete regression of low-grade MALT lymphomas with

antibiotic treatment has been reported in 70% to 100% of cases.
Lymphomas regress in response to H. pylori treatment.

 The median time to complete response averaged 5 months.

 For disease limited to the mucosa and submucosa, as is the case

in 90% of patients, antibiotics alone are sufficient.

 In the rare case of more advanced disease with extension into

the muscularis or serosa, nodal or adjacent organ involvement,
disease refractory to antibiotics, or systemic disease,
chemotherapy with or without radiotherapy should be considered
in addition to H. pylori eradication.

 Chemotherapy with cyclophosphamide, doxorubicin, vincristine,

and prednisone (CHOP) with rituximab and 40-50 Gy of
radiotherapy is thought to be standard management.