eMedicine Specialties > Hematology > Stem Cells and Disorders

Mucosa-Associated Lymphoid Tissue: Follow-up

Author: Sara J Grethlein, MD, Associate Dean for Graduate Medical Education, Professor, Department of Internal Medicine, Division of Hematology and Oncology, State University of New York Upstate Medical University
Coauthor(s): Jose A Perez Jr, MD, MSEd, MBA, Consulting Physician, Department of Internal Medicine, Residency Director, Vice Chair of Education Department of Medicine, The Methodist Hospital, Houston; Associate Professor of Clinical Medicine, Weill Cornell Medical College
Contributor Information and Disclosures

Updated: Oct 14, 2008

Follow-up

Further Outpatient Care

  • Patients with MALToma should continue to receive serial examinations at increasing frequencies for several years following the successful completion of therapy.

Prognosis

  • Generally, low-grade MALTomas are indolent neoplasms with a fairly good prognosis.
  • MALTomas that are not eradicated by treatment of H. pylori infection are incurable but are associated with a long course.
  • Although the intermediate-grade, diffuse, large B-cell MALTomas are more aggressive malignancies, the cure rate may be as high as 90% for stage IE disease and is approximately 30-40% for extensive stage IIIE or IVE disease. These outcomes are similar to non-MALT intermediate-grade NHLs.
  • Gastric MALTomas have a stage-dependent prognosis. The survival rate for stage IE disease is 93% at 5 years and 58% at 10 years.20 Long-term responses to anti– H. pylori treatment alone have been reported.
  • Nongastrointestinal MALTomas are most common in the head and neck, ocular adnexa, and lungs.
  • Several small studies have reported that observation alone may be appropriate in selected patients with ocular adnexal MALToma.
    • The prognosis depends on the grade of the tumor, with long-term survival possible for patients with low-grade tumors. However, achieving a cure is more difficult in patients with MALTomas in advanced stages.
    • Use of the International Prognostic Index — taking into account age, Ann Arbor stage, lactate dehydrogenase (LDH) levels, the number of extranodal sites, and performance status — has better characterized low-, intermediate-, and high-risk groups. Five-year survival rates in these groups are 99% for the low-risk groups; 85-88%, intermediate-risk groups; and 72%, for high-risk groups. Patients with early-stage MALToma may be curable with chemotherapy.
    • The risks and benefits of surgical or radiation therapy for MALTomas should be considered before proceeding.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose cancer is one of the most frequent reasons for medical malpractice actions. Suggestive symptoms should be thoroughly investigated.
  • Failure to diagnose the correct subtype of lymphoma and subsequent use of treatment for another type of lymphoma or other malignancy that is not optimal therapy for MALToma is a medicolegal hazard.
  • Inappropriately aggressive surgical, radiation, or medical therapy that results in serious injury or long-term disability is a potentially serious medicolegal hazard in the management of MALTomas.
 


More on Mucosa-Associated Lymphoid Tissue

Overview: Mucosa-Associated Lymphoid Tissue
Differential Diagnoses & Workup: Mucosa-Associated Lymphoid Tissue
Treatment & Medication: Mucosa-Associated Lymphoid Tissue
Follow-up: Mucosa-Associated Lymphoid Tissue
References
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Further Reading

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Keywords

mucosa-associated lymphoid tissue, lymphoid tissue, MALToma, MALT lymphoma, MALT, marginal zone B-cell lymphoma, lymph node, mucus membrane, mucus, mucosal tissue, tonsils, Peyer patches, Peyer's patches, vermiform appendix, non-Hodgkin lymphoma, non-Hodgkin's lymphoma, NHL, lymphoma, malignancy, malignancies, cancer, Hashimoto thyroiditis, Hashimoto's thyroiditis, Crohn disease, Crohn's disease, celiac disease, Sjögren syndrome,
gut-associated lymphoid tissue, GALT, bronchial/tracheal-associated lymphoid tissue, BALT, nose-associated lymphoid tissue, NALT, vulvovaginal-associated lymphoid tissue, VALT, gastric MALT lymphoma, nongastric MALT lymphoma, gastric MALToma, nongastric MALToma, human mucosa

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Contributor Information and Disclosures

Author

Sara J Grethlein, MD, Associate Dean for Graduate Medical Education, Professor, Department of Internal Medicine, Division of Hematology and Oncology, State University of New York Upstate Medical University
Sara J Grethlein, MD is a member of the following medical societies: American Society of Hematology
Disclosure: Nothing to disclose.

Coauthor(s)

Jose A Perez Jr, MD, MSEd, MBA, Consulting Physician, Department of Internal Medicine, Residency Director, Vice Chair of Education Department of Medicine, The Methodist Hospital, Houston; Associate Professor of Clinical Medicine, Weill Cornell Medical College
Jose A Perez Jr, MD, MSEd, MBA is a member of the following medical societies: American College of Physician Executives, American College of Physicians, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching; Schering Honoraria Speaking and teaching; Cephalon Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Troy H Guthrie, Jr, MD, Director of Cancer Institute, Baptist Medical Center
Troy H Guthrie, Jr, MD is a member of the following medical societies: American Federation for Medical Research, American Medical Association, American Society of Hematology, Florida Medical Association, Medical Association of Georgia, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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