Haematology: Gastric MALT lymphoma management

Why E is correct

For gastric MALT lymphoma, eradication of Helicobacter pylori is the first-line treatment regardless of stage, and antibiotic eradication leads to regression and cure in approximately 70-80% of patients. Because response can take months, endoscopic surveillance is used to monitor regression before considering second-line therapy. Radiotherapy, rituximab or chemotherapy are reserved for H. pylori-negative or eradication-refractory disease.

And why the others are not

• AIncorrect: involved-site radiotherapy is second-line, used for persistent, H. pylori-negative or eradication-refractory localised disease, not first-line in an H. pylori-positive patient.
• BIncorrect: gastrectomy is not standard management of gastric MALT lymphoma, which is treated with conservative organ-preserving approaches.
• CIncorrect: R-CHOP is reserved for transformed or disseminated aggressive disease, not first-line localised MALT lymphoma.
• DIncorrect: single-agent rituximab is a later-line option for non-responders, not the first step when H. pylori is positive.

Source Gastric MALT lymphoma - H. pylori eradication and radiotherapy — Zucca E, Arcaini L, Buske C, et al. Marginal zone lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(1):17-29. Supporting review: Ishikawa E, Nakamura M, Satou A, et al. Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era. Cancers (Basel). 2022;14(2):446.