Mucosa-associated lymphatic tissue lymphomas (MALT or MALToma) are forms of Marginal zone lymphomas that involve places outside the lymph nodes (gastrointestinal tract, thyroid, breast, or skin). They are indolent (slow growing) B-cell lymphomas, accounting for about 10% of all types of NHL.
Presentation
Most patients have their cancer diagnosed with stage I or stage II disease outside the lymph nodes. In general, patients have stomach pain, ulcers, or other localized symptoms, but rarely do they suffer from systemic complaints such as fatigue or fever. Many patients have a history of autoimmune disease such as helicobacter gastritis, Hashimoto's thyroiditis, or Sjogren's syndrome. It is most often diagnosed in people in their 60’s. But cases are sometimes found in people in their 20’s or 30’s.
Causes
The bacteria Helicobacter pylori has been shown to cause MALT in the digestive system in about 90% of cases. Chromosome abnormalities t(1;14)(p22;q32) and t(11;18)(q21;q21) have also been noted in this form of NHL.
Treatment
Gastric (in the digestive system) - treatment of Helicobacter pylori infection may resolve cases of local gastric involvement. After standard antibiotic regimens, 50% of patients show resolution of gastric MALT (when checked by endoscopy) after 3 months. Other patients may resolve after 12 to 18 months of observation. Stage III or IV disease may be treated with surgery or
CHOP chemotherapy with or without
radiation.
Non-gastric - localized involvement can be treated with
radiation or surgery. When in the lymph nodes, bone marrow, or blood marginal zone behaves like other indolent / low-grade lymphomas.
As with all
B-cell lymphomas, use of
immunotherapy drugs is possible and there are a number of
clinical trials running using newer
monoclonal antibody drugs like
Rituxan,
Bexxar, and
Zevalin to induce responses. Ask your doctor or browse the
trials page.
Care
I have been told of tenderness in the digestive system during or after treatment with gastric MALT. You will want to talk to your doctor and possibly the staff nutritionist about what to eat during and after treatment. A number of good books (
example) exist for people with cancer but consultation with your medical team is recommended.
Resources
January 2004 Paper: Bacterial Infection and MALT Lymphoma, Julie Parsonnet, M.D., and Peter G. Isaacson, N Engl J Med. 2004 Jan 15;350(3):239-48.
Patient Perspective - The MALT pages on Vera Bradova's NHLBCELL.org - informative and well researched.
There are two mailing lists/groups devoted to either MALT or gastric lymphomas. They are listed on the mailing list page.
The Hematopathology of Lymphoma
HealthAtoZ - MALT Lymphoma
Mucosa-Associated Lymphoid Tissue - eMedicine
MALT lymphoma - Cancer Research UK
Abstract: Bacterial Infection and MALT Lymphoma, Parsonnet and Isaacson, NEJM Volume 350:213-215 January 15, 2004 Number 3
Current Treatment - Abstract: Malt Lymphomas Malek SN et al. Curr Treat Options Oncol. 2003 Aug; 4(4): 269-79
Cancerbackup (UK) - MALT Lymphoma
The Hematopathology of Lymphoma
MALT Lymphoma Genetics from Cancer Genetics Web
Unusual Lymphoma Entities: Evaluation and Management by Vose, Fisher, and Lister, 1997 ASCO
Related Articles
Non-Hodgkin's Lymphoma Information Pages:
Non-Hodgkin's Lymphomas
Non-Hodgkin's Lymphoma: Diagnosis
Non-Hodgkin's Lymphoma: Aggressive Lymphomas
Non-Hodgkin's Lymphoma: Indolent Lymphomas
Non-Hodgkin's Lymphoma: Treatment
Non-Hodgkin's Lymphoma: Resources
Bone Marrow and Stem Cell Transplants
Other Pages of Interest:
Childhood Non-Hodgkin's Lymphoma Information
The Lymphoma Information Network
Books
Non-Hodgkin's Lymphomas, Peter M. Mauch (Editor), James O. Armitage (Editor), et al., 2004.
Section IV: Pathology, Biology, Clinical Evaluation, and Treatment Section
Chapter 22: Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Type
Excellent but Technical:
An Illustrated Guide to Skin Lymphomas, Cerroni, Gatter, Kerl, 2nd. Ed, 2005
Chapter 10: Marginal Zone Lymphoma and Cutaneous Immunocytoma
Malt Lymphomas (Medical Intelligence Unit (Unnumbered: 2003) by Emanuele Zucca and Francesco Bertoni, February 2004
Gastrointestinal Lymphoma: Future Perspectives (Recent Results in Cancer Research, 156) by Wolfgang Fischbach (Editor), Hardcover, Published February 2000 - technical
