Gastric mucosa-associated lymphoid tissue lymphoma with central nervous system involvement: a case report and 8-year follow-up

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is a form of low-grade B cell lymphoma that is associated with Helicobacter pylori (H. pylori) infection and has a generally favorable prognosis. It tends to remain localized for extended periods before dissemination to other body parts. H. pylori eradication therapy is essential in all gastric MALT lymphoma patients regardless of the disease stage. However, no conclusive treatment regimen for gastric MALT lymphoma with central nervous system (CNS) involvement has been established to date. Herein we present a case of a gastric MALT lymphoma patient with CNS involvement who was successfully treated via combination chemoimmunotherapy and intrathecal chemotherapy. A 53-year-old woman was diagnosed with stage IV gastric MALT lymphoma with CNS involvement in 2012. She underwent 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), 2 cycles of rituximab, and 10 cycles of intrathecal chemotherapy. Six months later, radiological testing revealed no evidence of disease. In 2019 a mass was discovered in her right parietal lobe. She again underwent 6 R-CHOP cycles and 8 intrathecal chemotherapy cycles. The patient is being actively followed without any evidence of recurrence. Based on this successful case, chemoimmunotherapy combined with intrathecal chemotherapy could possibly be used for the treatment of gastric MALT lymphoma with CNS involvement.