Chemotherapy for MALTomas—are we back to where we started?: Jager G, Neumeister P, Brezinschek R, et al., Treatment of Extranodal Marginal Zone B-Cell Lymphoma of Mucosal-Associated Lymphoid Tissue Type With Cladribine: A Phase II Study, JCO 2002;20:3872–7

Abstract

The authors undertook a prospective study to evaluate the activity of cladribine (2-CDA) in mucosal-associated lymphoid tissue lymphoma (MALTomas). Patients with histologically verified extranodal marginal zone B-cell MALT-type lymphoma were enrolled onto this prospective phase II study. Prior chemotherapy was an exclusion criterion, but patients relapsing after radiation therapy were included. Patients had full metastatic evaluations before therapy and were staged based on a modified Ann Arbor system. These evaluations included the following procedures: ophthalmological examination, ear, nose, throat examination including sonogram of salivary glands or magnetic resonance imaging if needed, gastroscopy with multiple biopsies, endosonography of the upper GI tract, enteroclysis, colonoscopy, CT of the thorax and abdomen, and bone marrow biopsy. Patients with Helicobacter pylori ( H. pylori)-associated gastric MALT-type lymphoma restricted to mucosa and submucosa (stage EI1) were enrolled only after demonstration of unresponsiveness to successful H. pylori eradication, but patients with more advanced gastric lymphoma (≥EI2) or extragastric MALT-type lymphoma were directly enrolled. The authors studied 26 consecutive patients (11 women and 15 men) with a median age of 65 yr (range 40–82) in the study. Patients were treated with 2-CDA at a dose of 0.12 mg/kg five times daily as a 2 h infusion repeated every 4 wk for a maximum of six cycles. This chemotherapy was given as an outpatient. Restaging to assess chemotherapy response was performed after every two cycles. Nineteen patients had gastric lymphoma, seven of whom had involvement of other organs, and seven had extragastric presentation. Eighteen of the gastric lymphoma patients were H. pylori positive. Six patients with gastric lymphoma stage EI1 were judged refractory because of persistence of lymphoma of at least 1 yr after successful H. pylori eradication. Success was achieved in these patients after a single course of antibiotic therapy. In addition, 12 patients who had stages higher than EI1 received antibiotic therapy parallel to initiation of 2-CDA. Antibiotic therapy was successful in 16 patients, whereas two patients had to receive second-line therapy. All assessable patients on the study responded to the chemotherapy. A complete response was seen in 84%, and a partial response was seen in 16%. The patients with primary gastric lymphoma had a complete response of 100% and those with primary extragastric lymphoma had a complete response of 43% and a partial response of 57%. The median time to response was 2 months. Toxicities were generally mild and were mainly hematological. The median time to progression had not been reached, though median follow-up is only 32 months. Three patients with gastric MALToma relapsed and were salvaged with radiation therapy. The authors concluded that 2-CDA is highly effective in patients with both gastric and extragastric MALTomas and can be safely administered as an outpatient.