Prognosis

MALT lymphoma is an indolent (low-grade) lymphoma and outcomes are generally favourable, particularly if disease is localised.[67]

Poor prognostic factors

These include poor performance status at time of diagnosis, the presence of t(11;18) translocation, and high-grade transformation. The t(11;18) translocation is associated with Helicobacter pylori-negative MALT tumours, poor response to H pylori eradication therapy, and a high incidence of presentation in advanced stage.

MALT International Prognostic Index (MALT-IPI)

MALT-IPI is a validated prognostic tool for gastric and non-gastric MALT lymphoma based on the following poor prognostic factors:[68]

  • Age ≥70 years

  • Advanced-stage disease (stage III or IV)

  • Elevated lactate dehydrogenase

A revised version of MALT-IPI includes multiple mucosal sites as an additional poor prognostic factor.[69]

Eradication therapy in localised H pylori-positive gastric MALT lymphoma

H pylori eradication therapy alone induces long-term remission in >60% of patients with localised H pylori-positive gastric MALT lymphoma.[70][71]​ Remission rate is significantly higher in:[72]

  • Patients with stage I lymphoma (compared with stage II lymphoma [78.4% vs. 55.6%, respectively])

  • Asian people (compared with white people [84.1% vs. 73.8%, respectively])

  • Lymphoma localised to the distal stomach (compared with proximal stomach [91.8% vs. 75.7%, respectively])

The remission rate is higher in patients without the t(11;18) translocation compared with those with the translocation (78% vs. 22.2%, respectively).[72] 

The length of time to achieve remission is variable, but may be >1 year.[23][73] 

Radiotherapy in H pylori-independent gastric MALT lymphoma

In patients with H pylori-independent gastric MALT lymphoma (all stages), complete pathological response rate with radiotherapy is 95%, with 5-year and 10-year overall survival rates of 94% and 79%, respectively.[74]

Chemoimmunotherapy in advanced-stage MALT lymphoma

In patients with advanced-stage MALT lymphoma, complete response rate with chemoimmunotherapy (rituximab plus cyclophosphamide, vincristine, and prednisolone [R-CVP]) is 60%, with estimated 3-year progression-free survival and overall survival rates of 59% and 95%, respectively.[75]

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