Clinical Management of Patients with Gastric MALT Lymphoma: A Gastroenterologist’s Point of View

SIMPLE SUMMARY: Gastric mucosa-associated lymphoid tissue (MALT) lymphomas represent rare gastric neoplasia usually localized and of indolent course, characterized by an abnormal proliferation of small B lymphocytes within the gastric mucosa, and derived from an acquired MALT as a result of chronic inflammation most frequently induced by chronic infection with Helicobacter pylori. Their clinical management includes proper staging and eradication of Helicobacter pylori, followed by other treatments if necessary, as well as appropriate surveillance, given an increased risk of gastric adenocarcinoma and other cancers in this context. The aim of this review is to describe the latest achievements in the clinical management of these lymphomas with a special emphasis on the role of the Gastroenterologist. ABSTRACT: Gastric mucosa-associated lymphoid tissue (MALT) lymphomas (GML) are non-Hodgkin lymphomas arising from the marginal zone of the lymphoid tissue of the stomach. They are usually induced by chronic infection with Helicobacter pylori (H. pylori); however, H. pylori-negative GML is of increasing incidence. The diagnosis of GML is based on histological examination of gastric biopsies, but the role of upper endoscopy is crucial since it is the first step in the diagnostic process and, with currently available novel endoscopic techniques, may even allow an in vivo diagnosis of GML per se. The treatment of GML, which is usually localized, always includes the eradication of H. pylori, which should be performed even in H. pylori-negative GML. In the case of GML persistence after eradication of the bacteria, low-dose radiotherapy may be proposed, while systemic treatments (immunochemotherapy) should be reserved for very rare disseminated cases. In GML patients, at diagnosis but even after complete remission, special attention must be paid to an increased risk of gastric adenocarcinoma, especially in the presence of associated gastric precancerous lesions (gastric atrophy and gastric intestinal metaplasia), which requires adequate endoscopic surveillance of these patients.