No advantage for chlorambucil maintenance therapy in gastric MALT lymphoma

Abstract

Introduction: In the 1980s, Isaacson and colleagues [1,2] described a malignant lymphoma that occurred in association with mucosa-associated lymphoid tissue (MALT). These small-cell lymphomas were shown to have an indolent course and sometimes were cured with surgery or involved-fi eld radiotherapy. These lesions were previously sometimes called “pseudo lymphomas.” It became apparent that they could occur at any site of epithelial tissue—not just at mucosal sites. The most common MALT lymphomas occur in the stomach. In the 1990s, Wotherspoon and colleagues [3] documented the association of gastric MALT lymphomas and Helicobacter pylori infection, and it was shown that the lymphoma could regress when the H. pylori was eradicated [4]. Although H. pylori eradication has become the standard therapy for patients with localized gastric MALT lymphomas with documented infection by the microorganism, other therapies are also effective. Patients can respond to single-agent or combination chemotherapy regimens, rituximab alone or in combination, and involved-fi eld radiotherapy. In fact, the highest proportion of durable remissions seems to be associated with radiotherapy [5]. In this study, investigators from the International Extranodal Lymphoma Study Group, the United Kingdom Lymphoma Group, and the Group d’Etude des Lymphomes de l’Adulte tested the value of adjuvant chlorambucil after H. pylori eradication therapy in patients with nonprogressive gastric MALT lymphomas.