TAILIEUCHUNG - Chapter 105. Malignancies of Lymphoid Cells (Part 16)

Evaluation of patients with MALT lymphoma follows the pattern (Table 105-11) for staging a patient with non-Hodgkin's lymphoma. In particular, patients with gastric lymphoma need to have studies performed to document the presence or absence of H. pylori infection. Endoscopic studies including ultrasound can help define the extent of gastric involvement. Most patients with MALT lymphoma have a good prognosis, with a 5-year survival of ~75%. In patients with a low IPI score, the 5-year survival is ~90%, while it drops to ~40% in patients with a high IPI score. Mucosa-Associated Lymphoid Tissue Lymphoma: Treatment MALT lymphoma is often localized. Local. | Chapter 105. Malignancies of Lymphoid Cells Part 16 Evaluation of patients with MALT lymphoma follows the pattern Table 105-11 for staging a patient with non-Hodgkin s lymphoma. In particular patients with gastric lymphoma need to have studies performed to document the presence or absence of H. pylori infection. Endoscopic studies including ultrasound can help define the extent of gastric involvement. Most patients with MALT lymphoma have a good prognosis with a 5-year survival of 75 . In patients with a low IPI score the 5-year survival is 90 while it drops to 40 in patients with a high IPI score. Mucosa-Associated Lymphoid Tissue Lymphoma Treatment MALT lymphoma is often localized. Local therapy such as radiation or surgery can effect cure and this is one of the few times where surgery might be a reasonable primary therapy for a patient with non-Hodgkin s lymphoma. Patients with gastric MALT lymphomas who are infected with H. pylori can achieve remission in the majority of cases with eradication of the infection. These remissions can be durable but molecular evidence of persisting neoplasia is frequent and the long-term outcome is uncertain. Patients who present with more extensive disease are most often treated with single-agent chemotherapy such as chlorambucil. Data on combination regimens that include rituximab are being generated but its efficacy in other B cell tumors and low toxicity support its use. Coexistent diffuse large B cell lymphoma must be treated with combination chemotherapy see below . The additional acquired mutations that mediate the histologic progression also convey Helicobacter independence to the growth. Mantle Cell Lymphoma Mantle cell lymphoma makes up 6 of all non-Hodgkin s lymphomas. This lymphoma was previously placed in a number of other subtypes. Its existence was confirmed by the recognition that these lymphomas have a characteristic chromosomal translocation t 11 14 between the immunoglobulin heavy chain gene on chromosome 14 and

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