MALT Lymphoma: Symptoms, Causes, Diagnosis, Treatment, and Prognosis

~Introduction

MALT Lymphoma, formally known as Mucosa-Associated Lymphoid Tissue Lymphoma, is a rare and slow-growing type of non-Hodgkin lymphoma (NHL). It arises from B lymphocytes and typically develops in tissues that are normally free of lymphoid cells but acquire them due to chronic inflammation or infection. Because of its indolent nature, MALT lymphoma often progresses slowly and may remain localized for long periods, making early diagnosis and appropriate management critical for favorable outcomes.

This comprehensive guide explores everything you need to know about MALT lymphoma, including its causes, symptoms, diagnosis, staging, treatment options, prognosis, and prevention—optimized for search engines and written for both medical professionals and patients.

~What Is MALT Lymphoma?

MALT lymphoma is a subtype of extranodal marginal zone B-cell lymphoma, accounting for approximately 7–8% of all non-Hodgkin lymphomas. “Extranodal” means it originates outside the lymph nodes, most commonly in mucosal tissues such as the stomach, lungs, salivary glands, thyroid, skin, or eyes.

The disease was first described in the 1980s and has since become recognized as a distinct clinical entity due to its strong association with chronic infections and autoimmune disorders.

~Types of MALT Lymphoma by Site

MALT lymphoma can develop in various organs, with symptoms depending on the affected area:

1. Gastric MALT Lymphoma

• Most common form

• Strongly associated with Helicobacter pylori (H. pylori) infection

• Often presents with indigestion or stomach pain

2. Pulmonary MALT Lymphoma

• Affects lung tissue

• May cause cough, shortness of breath, or chest discomfort

3. Ocular Adnexal MALT Lymphoma

• Involves tissues around the eyes

• Associated with Chlamydia psittaci infection in some regions

4. Salivary Gland MALT Lymphoma

• Often linked to Sjögren’s syndrome

• Causes painless swelling of salivary glands

5. Thyroid MALT Lymphoma

• Common in patients with Hashimoto’s thyroiditis

• May present as a thyroid mass

~Causes and Risk Factors of MALT Lymphoma

The exact cause of MALT lymphoma is not fully understood, but it is strongly associated with chronic immune stimulation.

Major Causes

• Chronic infections

  • Helicobacter pylori (gastric MALT lymphoma)

  • Chlamydia psittaci (ocular MALT lymphoma)

  • Campylobacter jejuni (intestinal MALT lymphoma)

• Autoimmune diseases

  • Sjögren’s syndrome

  • Hashimoto’s thyroiditis

  • Rheumatoid arthritis

Risk Factors

• Persistent inflammation

• Older age (median age 50–60 years)

• Weakened immune system

• Long-standing autoimmune conditions

~Symptoms of MALT Lymphoma

MALT lymphoma symptoms are often mild or nonspecific, especially in early stages.

Common Symptoms

• Fatigue

• Unexplained weight loss

• Night sweats

• Low-grade fever

Site-Specific Symptoms

• Stomach: Abdominal pain, nausea, bloating, indigestion

• Lungs: Chronic cough, shortness of breath

• Eyes: Swelling, redness, vision changes

• Salivary glands: Painless swelling

• Thyroid: Neck mass or difficulty swallowing

Because symptoms are subtle, many cases are discovered incidentally during routine investigations.

~Diagnosis of MALT Lymphoma

Accurate diagnosis requires a combination of clinical evaluation, imaging, and laboratory tests.

Diagnostic Tests

1. Biopsy

   • Essential for confirmation

   • Shows characteristic marginal zone B cells

2. Endoscopy

   • Commonly used for gastric MALT lymphoma

   • Allows direct visualization and tissue sampling

3. Imaging Studies

   • CT scan or PET scan

   • Helps determine disease spread

4. Laboratory Tests

   • Complete blood count (CBC)

   • Liver and kidney function tests

   • Tests for H. pylori or autoimmune markers

5. Molecular Testing

   • Detects chromosomal abnormalities such as t(11;18)(q21;q21)

~Staging of MALT Lymphoma

MALT lymphoma is staged using the Ann Arbor staging system, adapted for extranodal disease.

• Stage I: Localized to one organ

• Stage II: Involvement of nearby lymph nodes

• Stage III: Lymph nodes on both sides of the diaphragm

• Stage IV: Disseminated disease involving multiple organs

Most patients are diagnosed at early stages (Stage I or II).

~Treatment Options for MALT Lymphoma

Treatment depends on the site, stage, and underlying cause of the lymphoma.

1. Antibiotic Therapy (for Gastric MALT Lymphoma)

• First-line treatment for H. pylori–positive cases

• Triple therapy includes:

  • Proton pump inhibitor

  • Two antibiotics

• Can lead to complete remission in up to 80% of patients

2. Radiation Therapy

• Highly effective for localized disease

• Often used when antibiotics fail or for non-gastric MALT lymphoma

3. Immunotherapy

• Rituximab (anti-CD20 monoclonal antibody)

• Used alone or in combination with chemotherapy

4. Chemotherapy

• Reserved for advanced or refractory disease

• Common regimens include:

  • Bendamustine + Rituximab

  • CHOP-based therapy (less common)

5. Watchful Waiting

• Suitable for asymptomatic patients with indolent disease

• Regular monitoring without immediate treatment

~Prognosis and Survival Rates

MALT lymphoma generally has an excellent prognosis due to its slow-growing nature.

Survival Statistics

• 5-year survival rate: 85–95%

• Localized disease has better outcomes than advanced stages

• Transformation to aggressive lymphoma is rare but possible

Prognosis depends on:

• Stage at diagnosis

• Site of involvement

• Response to initial treatment

• Presence of genetic abnormalities

~Complications and Disease Progression

Although indolent, MALT lymphoma can lead to complications if untreated:

• Progression to advanced stages

• Transformation into diffuse large B-cell lymphoma (DLBCL)

• Organ dysfunction due to tumor growth

Regular follow-up is essential to detect recurrence or progression early.

~Prevention and Risk Reduction

While MALT lymphoma cannot always be prevented, certain measures can reduce risk:

• Early treatment of H. pylori infection

• Management of autoimmune diseases

• Regular medical check-ups for high-risk individuals

• Avoiding chronic untreated inflammation

~Living With MALT Lymphoma

Most patients with MALT lymphoma can maintain a good quality of life. Long-term follow-up is crucial, as relapses can occur even years after remission.

Supportive Care Includes:

• Nutritional support

• Psychological counseling

• Regular monitoring with imaging and lab tests

~Frequently Asked Questions (FAQs)

Is MALT lymphoma curable?

Yes, many cases—especially gastric MALT lymphoma—are curable with appropriate treatment.

Is MALT lymphoma cancer?

Yes, it is a type of non-Hodgkin lymphoma, which is a cancer of the lymphatic system.

Can MALT lymphoma come back?

Relapse is possible, but most recurrences are treatable.

~Conclusion

MALT lymphoma is a unique and highly treatable form of non-Hodgkin lymphoma, often linked to chronic infections or autoimmune diseases. With early diagnosis and targeted therapy, most patients achieve long-term remission and excellent survival outcomes. Increased awareness, timely investigation of symptoms, and personalized treatment approaches remain the cornerstone of successful management.

If you or a loved one has been diagnosed with MALT lymphoma, consultation with a hematologist-oncologist is essential to develop the most effective treatment plan.