Gastric and ocular MALT Lymphoma: infectious agent-directed or radiation therapy, which is more appropriate?

In August 2015, Stephen M. Ansell, MD PhD, of the Mayo Clinic published a comprehensive review focusing on the diagnosis and treatment of Non-Hodgkin Lymphoma (NHL) in Mayo Clinic Proceedings.1

In a letter to the editor2, J.Y. Luh of St. Joseph Hospital, Eureka, CA, and Oregon Health and Science University, Portland, and colleagues commended Ansell “on his excellent review”. The focus of their letter was the Marginal Zone Lymphoma discussion in Ansell’s review.

  • In Ansell’s review, Helicobacter pylori-directed treatment is appropriate for gastric Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma
  • Luh et al. add that radiation therapy should be considered in gastric MALT Lymphoma patients who:
    • Are non-responders to pylori-directed treatment
    • Do not have any evidence of infection with pylori
    • Have the chromosome translocation t(11;18)
  • They also add that there is much evidence suggesting involved-field radiation therapy directed to the whole stomach at 25–30Gy in 1.5Gy fractions is a highly effective (CR = 98% over 5 years) and well tolerated treatment option3-5
  • Similarly, for ocular MALT Lymphoma, Ansell’s review states that using doxycycline as Chlamydia psittaci-directed treatment is a beneficial first-line strategy
  • Luh et al. suggest that locoregional radiation is effective in limited stage I-II disease and there is evidence indicating that 25–30Gy is well tolerated by ocular structures6


  1. Ansell S.M. Non-Hodgkin Lymphoma: Diagnosis and Treatment. Mayo Clin Proc. 2015 Aug; 90(8):1152–1163. doi: 10.1016/j.mayocp.2015.04.025.
  2. Luh J.Y. et al. Radiation Therapy in Gastric and Ocular Marginal Zone Lymphomas. Mayo Clin Proc. 2016 Jan; 91(1):123. doi: 10.1016/j.mayocp.2015.10.012.
  3. Eng T.Y. & Ha C.S. IGRT for gastric lymphoma. In: Macklis RM, Conti PS, eds. Image-Guided Radiotherapy and Functional Imaging in Modern Lymphoma Management. City, UK: Informa Healthcare; 2010.
  4. Wirth A. et al. Longterm outcome for gastric marginal zone lymphoma treated with radiotherapy: a retrospective, multicentre, International Extranodal Lymphoma Study Group study. Ann Oncol. 2013; 24(5):1344–1351.
  5. Tomita N. et al. Favorable outcomes of radiotherapy for early-stage mucosa-associated lymphoid tissue lymphoma. Radiother Oncol. 2009; 90(2):231–235.
  6. Harada K. et al. Localized ocular adnexal mucosa-associated lymphoid tissue lymphoma treated with radiation therapy: a longterm outcome in 86 patients with 104 treated eyes. Int J Radiat Oncol Biol Phys. 2014; 88(3):650–654.
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