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 option^3-5
• 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