Skip to content
My WebMD Sign In, Sign Up

Non-Hodgkin's Lymphoma

Font Size

Cellular Classification

continued...

Many patients have a history of autoimmune disease, such as Hashimoto’s thyroiditis or Sjögren’s syndrome, or of Helicobacter gastritis. Most patients present with stage I or stage II extranodal disease, which is most often in the stomach. Treatment of Helicobacter pylori infection may resolve many cases of localized gastric involvement.[50,52,53,54,55,56] After standard antibiotic regimens, 50% of patients show resolution of gastric MALT by endoscopy after 3 months. Other patients may show resolution after 12 to 18 months of observation. Of the patients who attain complete remission, 30% demonstrate monoclonality by immunoglobulin heavy chain rearrangement on stomach biopsies with a 5-year median follow-up.[57] The clinical implication of this finding is unknown. Translocation t(11;18) in patients with gastric MALT predicts for poor response to antibiotic therapy, for Helicobacter pylori–negative testing, and for poor response to oral alkylator chemotherapy.[58,59] Stable asymptomatic patients with persistently positive biopsies have been successfully followed on a watchful waiting approach until disease progression.[55,56] Patients who progress are treated with radiation therapy,[60,61,62] rituximab,[63] surgery (total gastrectomy or partial gastrectomy plus radiation therapy),[64] chemotherapy,[48] or combined modality therapy.[65] The use of endoscopic ultrasonography may help clinicians to follow responses in these patients.[66]

Localized involvement of other sites can be treated with radiation or surgery.[61,62,67] Patients with extragastric MALT lymphoma have a higher relapse rate than patients with gastric MALT lymphoma in some series, with relapses many years and even decades later.[68] Many of these recurrences involve different MALT sites than the original location. When disseminated to lymph nodes, bone marrow, or blood, this entity behaves like other low-grade lymphomas.[49,69] Extragastric MALT lymphoma does not respond to antibiotic treatment.[70] For patients with ocular adnexal MALT, antibiotic therapy using doxycycline targeting Chlamydia psittaci resulted in durable remissions for several patients in a small anecdotal series.[71][Level of evidence: 3iiiDiii] Large B-cell lymphomas of MALT sites are classified and treated as diffuse large cell lymphomas.[72] Three small case series (two retrospective and one prospective) report durable complete remissions after treatment of Helicobacter pylori in patients with aggressive lymphoma (complete remission rate of 35%–88% and a median duration of 21–60 months).[73,74,75]

Patients with nodal marginal zone lymphoma (monocytoid B-cell lymphoma) are treated with the same paradigm of watchful waiting or therapies as described for follicular lymphoma. Among patients with concomitant HCV infection, the majority attain a complete or partial remission after loss of detectable HCV RNA with treatment using interferon-a with or without ribavirin.[42][Level of evidence: 3iiiDiii]

The disease variously known as Mediterranean abdominal lymphoma, heavy chain disease, or immunoproliferative small intestinal disease (IPSID) (which occurs in young adults in eastern Mediterranean countries) is another version of MALT lymphoma, which responds to antibiotics in its early stages.[76] Campylobacter jejuni has been identified as one of the bacterial species associated with IPSID, and antibiotic therapy may result in remission of the disease.[77]

1|2|3|4|5|6|7|8|9|10|11|12|13

WebMD Public Information from the National Cancer Institute

Last Updated: April 02, 2007
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

Today on WebMD

what is your cancer risk
HEALTH CHECK
Integrative Medicine Cancer Quiz
QUIZ
 
cancer fighting foods
SLIDESHOW
Your Cancer Specialists Doctors You Need To Know
REFERENCE
 

Vitamin D
SLIDESHOW
New Treatments For Non-Hodgkins Lymphoma
FEATURE
 
Lifestyle Tips for Depression Slideshow
SLIDESHOW
Pets Improve Your Health
SLIDESHOW
 

WebMD Special Sections