MALT Lymphoma

What is MALT lymphoma?

MALT (mucosa-assisted lymphoid tissue) lymphoma is a rare subtype of non-Hodgkin lymphoma. It’s the most common form of marginal zone lymphoma, a group of slow-growing lymphomas. MALT lymphoma typically affects people age 65 and older. It’s more common in men and people assigned male at birth (AMAB) than in women and people assigned female at birth (AFAB). Healthcare providers have treatments that put it into remission, but the condition can come back.

What are types of MALT lymphoma?

There are two MALT lymphoma types:

• Gastric MALT lymphoma develops in your belly. It starts in your belly’s inner lining, or mucosa. This condition typically stays where it started, but it can spread to areas outside your belly. It’s the most common type of MALT lymphoma.
• Non-gastric MALT lymphoma can affect tissue lining your lungs, salivary glands, thyroid or skin. It can also affect tissue around your eye, such as your tear ducts.

How common is this condition?

MALT lymphoma is rare, accounting for 7% of all non-Hodgkin lymphomas. The American Cancer Society estimates that in 2023, 80,550 people will be diagnosed with non-Hodgkin lymphoma. For context, 300,590 people will receive a breast cancer diagnosis.

How fast does MALT lymphoma spread?

This condition grows very slowly. Early on, it may not cause noticeable symptoms. In some cases, people receive a MALT lymphoma diagnosis while undergoing tests for unrelated medical issues.

What are the symptoms?

Symptoms vary depending on the lymphoma’s location, but all MALT lymphomas start in mucosa. Mucosa (mucous membrane) is the moist inner lining of some organs and cavities throughout your body. Non-gastric MALT lymphoma develops in several organs, but the gastric form develops only in your belly.

Gastric MALT lymphoma symptoms

Gastric MALT lymphoma may cause the following:

• Heartburn and indigestion.
• Belly pain.
• Nausea and vomiting.
• Loss of appetite.
• Unexplained weight loss.
• Gastrointestinal bleeding.

Non-gastric MALT lymphoma symptoms

This condition may affect your eyes, lungs, salivary glands, skin and thyroid gland.

Eyes

• Drooping eyelids.
• Irritated or reddened eyes.
• Swelling around your eyes.
• Double vision.

Lungs

• Shortness of breath.
• Chest pain.
• Coughing or coughing up blood.

Salivary Glands

Swelling in glands located:

• In front of your ears.
• Under your chin.
• In your mouth.

Skin

• Red, pink or purple patches on your skin.
• Lumps on your skin.

Thyroid

• Hypothyroidism symptoms, including fatigue, dry skin, unexplained weight gain or feeling more sensitive to cold.
• A lump at the front of your neck.

What causes MALT lymphoma?

The condition’s causes include bacterial or viral infections and autoimmune disorders.

• Bacteria and viruses:Chronic H. pylori infection is a common gastric MALT cause. Other bacteria, including Achromobacter xylosoxidans, Campylobacter jejuni, Borrelia burgdorferi and C. psittiaci, are associated with both MALT lymphoma types. Hepatitis C is associated with both gastric and non-gastric MALT lymphoma.
• Autoimmune disorders:Hashimoto’s disease and Sjӧgren’s syndrome may cause certain non-gastric MALT lymphomas.

What are the risk factors for MALT lymphoma?

Having a family history of lymphoma may increase your risk of developing MALT lymphoma.

How is MALT lymphoma diagnosed?

Healthcare providers use several tests to diagnose and evaluate the condition. Some tests help diagnose it; others determine how far MALT lymphoma has spread.

Blood tests

Providers may do the following blood tests:

• CBC (complete blood count).
• LDH (lactate dehydrogenase).
• CMP (comprehensive metabolic panel).
• Hepatitis C test.

Biopsy

Healthcare providers may perform a:

• Bone marrow biopsy.
• Needle biopsy.

Providers may do biopsies as part of an upper endoscopy to examine your upper digestive tract.

Imaging tests

Providers may do these tests to determine lymphoma location and stage:

• Computed tomography (CT) scans.
• Positron emission tomography (PET) scans.

Laboratory tests

Medical pathologists may use the following tests to examine tissue or cancer cells:

• H. pylori test.
• Flow cytometry.

Cancer staging (gastric MALT lymphoma)

Healthcare providers use cancer staging systems to plan treatment and develop prognoses or expected outcomes after treatment. They may use the following system to stage gastric MALT lymphoma:

• Stage I: Cancer in the inner lining of your belly.
• Stage II: Cancer in nearby lymph nodes, more distant lymph nodes or in nearby organs and tissues.
• Stage IV: Cancer in several lymph nodes in your bone marrow and above and below your diaphragm.

*There isn’t a Stage III for gastric MALT lymphoma.

How is MALT lymphoma treated?

Treatments depend on factors like the type of MALT lymphoma, the cause and the condition stage. For example, some studies suggest antibiotics may eliminate some early-stage gastric MALT lymphoma. Treatments may include:

• Watchful waiting/active surveillance: Providers may recommend watchful waiting for people with early-stage MALT lymphoma who aren’t experiencing symptoms.
• Antibiotics:This treatment eliminates the H. pylori bacteria causing gastric MALT lymphoma. Some studies suggest eliminating H. pylori may cure the condition.
• Radiation therapy:Providers may treat use radiation to treat both types of MALT lymphoma.
• Monoclonal antibody therapy:This treatment may help people with gastric MALT lymphoma that hasn’t responded to radiation therapy or who have non-gastric MALT lymphoma.

Can MALT lymphoma be prevented?

Medical researchers don’t know all the reasons why people develop this condition. One study suggested avoiding H. pylori infections may reduce gastric MALT lymphoma risk.

Can MALT lymphoma be cured?

Antibiotics may cure early-stage gastric MALT lymphoma by eliminating the bacteria that causes it. Treatments may put the condition into remission, but it can come back.

What is the prognosis?

People may live for many years with MALT lymphoma, even if the condition comes back (recurs) after treatment.

What is the survival rate?

One study suggests 88% of people with MALT lymphoma are alive five years after diagnosis. Keep in mind survival rates are estimates based on other people’s experiences and data collected over time. Your experience may be different. In this case, your healthcare provider is your best resource for information.

How do I take care of myself?

Most people will need lifelong medical support, including regular tests to determine if the condition has come back. In general, you’ll have follow-up lab and imaging tests every three to six months for five years, and then annual follow-up tests.

When should I see my healthcare provider?

People with MALT lymphoma typically have regular follow-up appointments. Contact your provider if:

• You have MALT lymphoma and notice changes in your body that may be symptoms.
• You’re getting treatment and your symptoms get worse.
• You’re in remission, and notice changes that could indicate your condition is coming back (recurring).

What questions should I ask my healthcare provider?

• What type of MALT lymphoma do I have?
• What is my condition stage?
• Do I need treatment?
• If I need treatment, what treatment do you recommend?
• Are there clinical trials I should consider?

A note from Cleveland Clinic

MALT (mucus-associated-lymphoid tissue) lymphoma is a rare subtype of non-Hodgkin lymphoma. It affects the tissue that lines your organs and other areas of your body. It grows very slowly and often doesn’t cause noticeable symptoms. Healthcare providers can treat and sometimes cure MALT lymphoma. But the condition often comes back, and you may need more treatment. If you have this condition, ask your provider what you can expect.