Role of chemotherapy in gastric MALT lymphoma, diffuse large B-cell lymphoma and other lymphomas

Primary gastrointestinal lymphomas are relatively common, with the large majority occurring in the stomach. In the commonest histological subtype, i.e. diffuse large B-cell lymphoma (DLCBL), chemotherapy has widely been applied in the past, either following surgery or – in more recent years – as part of conservative management in combination with radiotherapy. Relatively little data, however, exist for chemotherapy as sole treatment modality in localised gastric DLBCL, which nevertheless are highly promising and suggest that combination therapy might overtreat a substantial proportion of patients. In gastric MALT-lymphoma, the use of chemotherapy has been restricted either to patients with a priori disseminated disease or individuals judged to be at high risk or failing local treatment approaches. Only a few prospective phase II studies have been performed, and one controlled trial has shown that chemotherapy was superior in terms of event free survival at ten years when compared to radiation and surgery. These suggest that systemic treatment approaches might be highly effective both in gastric DLBCL as well as MALT-lymphoma, and the scope of this article is to briefly summarize current data on chemotherapy in gastric and GI-lymphomas according to histologic subtypes.