Management of gastric marginal zone lymphoma

MZL: marginal zone lymphoma; CR: complete response; RT: radiation therapy; GI: gastrointestinal.
* Localized (stage IE or II) disease includes a single primary lesion or multiple, noncontiguous lesions confined to the GI tract that may have nodal involvement.
¶ Tumor biopsy should be tested for Helicobacter pylori. If H. pylori is negative by histopathology, evaluate with noninvasive testing (stool antigen test or urea breath test).
Δ Four weeks after the completion of H. pylori eradication therapy, testing should be performed to confirm eradication of infection. Up to 20% of patients will require a second H. pylori eradication regimen to fully eliminate the infection. We offer up to three eradication regimens before pursuing alternative therapies.
◊ We typically perform endoscopy with biopsies every three months until a histologic complete response (CR) is attained, and then perform endoscopy every six months for at least the first two years and then suggest endoscopy every 18 months and as clinically indicated. Surveillance can stop in asymptomatic patients once two sequential endoscopies show no abnormalities on biopsy. Surveillance endoscopy evaluates for recurrence and for gastric adenocarcinoma; surveillance is especially important for those with persistent chronic gastritis that may have components of gastric atrophy or gastric/intestinal metaplasia.
§ The systemic therapies used for MZL include single agent rituximab and the combination of rituximab and chemotherapy (eg, bendamustine rituximab). These therapies are not curative, but may control symptoms and prolong survival.