Treatment of extranodal marginal zone B-cell lymphomas (MALT-lymphomas)
EHA Library. Raderer M. 06/14/17; 185012
Topic: 3Ah Marginal zone lymphomas
Prof. Dr. Markus Raderer
Contributions
Contributions
Learning Objectives
Pauline Brice - Chair Introduction
Indolent B – cell lymphomas have a good prognosis with a low rate of mortality, but relapses are frequent even late and for the advanced stages they are usually not curable diseases. Molecular techniques have shed new light on the pathobiology of indolent lymphoma and helped to identify lesions with prognostic implications and therapeutic targets. Some specific biological abnormalities may help for targeted therapies; like In HCL the high frequency of BRAF mutations may suggest a key role in the pathogenesis of the disease or MYD88 in LPL lymphomas. The survival of FL has dramatically increased since 1997 with the use of Rituximab° initially in relapse setting than in first line. Patients with a high-tumor burden need chemotherapy (CT) combined with rituximab and this CT may expose them to long term complication (secondary malignancies, cardiac toxicity…) mostly for patients experiencing multiple relapses. New agents are studied in this setting e.g. Antibodies drug conjugates, intracellular targets or drugs targeting the microenvironment. The high efficacy of these drugs used alone or with antiCD20 antibodies let us hope that they will soon be used in first line delaying the time to CT.
Management of MALT lymphomas has evolved among time but for gastric lymphoma it must begin with antibiotics for Helicobacter Pylori eradication, stage I disease can receive radiation therapy at 30 gys and for advanced stages if a treatment is required the best published combination is represented by Rituximab /chlorambucil, but new agents have shown efficacy like LENALIDOMIDE and IBRUTINIB.
Learning Objectives of the manuscript
After viewing this presentation the participant will be able to:
- There is still a place for watchful waiting in asymptomatic patients.
- Major changes in identification of new therapeutic targets in indolent lymphomas.
- New agents studied in this setting (antibodies, intracellular targets or drugs targeting the microenvironment).
- Development of targeted treatments delaying the time to first chemotherapy in advanced patients requiring therapy.
Learning Objectives of the presentation:
After viewing this presentation the participant will be able to:
- Eradication of Helicobacter pylori remains the preferred first-line therapy in patients with gastric MALT lymphoma.
- Also patients with HP-negative gastric MALT lymphoma may also be managed with (clarithromycin-based) antibiotic therapy.
- Antibiotic therapy can also be given in patients with ocular adnexal MALT-lymphomas as sole initial management.
- Both systemic treatment as well as radiotherapy appear to have curative potential in localised disease.
Indolent B – cell lymphomas have a good prognosis with a low rate of mortality, but relapses are frequent even late and for the advanced stages they are usually not curable diseases. Molecular techniques have shed new light on the pathobiology of indolent lymphoma and helped to identify lesions with prognostic implications and therapeutic targets. Some specific biological abnormalities may help for targeted therapies; like In HCL the high frequency of BRAF mutations may suggest a key role in the pathogenesis of the disease or MYD88 in LPL lymphomas. The survival of FL has dramatically increased since 1997 with the use of Rituximab° initially in relapse setting than in first line. Patients with a high-tumor burden need chemotherapy (CT) combined with rituximab and this CT may expose them to long term complication (secondary malignancies, cardiac toxicity…) mostly for patients experiencing multiple relapses. New agents are studied in this setting e.g. Antibodies drug conjugates, intracellular targets or drugs targeting the microenvironment. The high efficacy of these drugs used alone or with antiCD20 antibodies let us hope that they will soon be used in first line delaying the time to CT.
Management of MALT lymphomas has evolved among time but for gastric lymphoma it must begin with antibiotics for Helicobacter Pylori eradication, stage I disease can receive radiation therapy at 30 gys and for advanced stages if a treatment is required the best published combination is represented by Rituximab /chlorambucil, but new agents have shown efficacy like LENALIDOMIDE and IBRUTINIB.
Learning Objectives of the manuscript
After viewing this presentation the participant will be able to:
- There is still a place for watchful waiting in asymptomatic patients.
- Major changes in identification of new therapeutic targets in indolent lymphomas.
- New agents studied in this setting (antibodies, intracellular targets or drugs targeting the microenvironment).
- Development of targeted treatments delaying the time to first chemotherapy in advanced patients requiring therapy.
Learning Objectives of the presentation:
After viewing this presentation the participant will be able to:
- Eradication of Helicobacter pylori remains the preferred first-line therapy in patients with gastric MALT lymphoma.
- Also patients with HP-negative gastric MALT lymphoma may also be managed with (clarithromycin-based) antibiotic therapy.
- Antibiotic therapy can also be given in patients with ocular adnexal MALT-lymphomas as sole initial management.
- Both systemic treatment as well as radiotherapy appear to have curative potential in localised disease.
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