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Z Gastroenterol 2022; 60(04): 602-612
DOI: 10.1055/a-1676-5104
Übersicht

Gastrale MALT-Lymphome – von pathogenetischen Erkenntnissen zu konsequenter Deeskalation der Therapie

Gastric MALT lymphoma – from pathogenetic insights to consequent deescalation of therapy
Wolfgang Fischbach
1   Gastroenterologie Aschaffenburg, Aschaffenburg, Germany
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Zusammenfassung

Das gastrale MALT (mucosa-associated-lymphoid-tissue) -Lymphom ist das häufigste gastrointestinale Lymphom. Über Jahrzehnte hinweg galten zunächst die Operation und später Bestrahlung und Chemotherapie als etablierte Therapiestandards. Vor etwa 30 Jahren wurde die pathogenetische Bedeutung der Helicobacter-pylori-Infektion für die Entstehung des gastralen MALT-Lymphoms deutlich. In den folgenden Jahren wurden die pathogenetischen Erkenntnisse konsequent in die klinische Medizin umgesetzt. Dies hat zu einer radikalen Änderung der Therapie dieser Lymphome geführt. Heute ist international die Helicobacter-pylori-Eradikation als Therapie der ersten Wahl anerkannt. Sie führt in den meisten Fällen zu einer Lymphomregression. Die Langzeitprognose der Patienten nach alleiniger Eradikationsbehandlung ist exzellent, selbst dann, wenn endoskopische und/oder histologische Residuen bestehen bleiben und eine „Watch-and-wait“-Strategie gewählt wird.

Die pathogenetischen Erkenntnisse und ihre klinische Anwendung haben zu einer konsequenten Therapiedeeskalation bei den gastralen MALT-Lymphomen geführt. Die vorliegende Übersicht zeigt die einzelnen Schritte dieser Entwicklung und gibt eine Empfehlung zum aktuellen Management von Patienten mit gastralen MALT-Lymphomen.

Abstract

Gastric MALT- (mucosa-associated-lymphoid-tissue) lymphoma represents the most frequent gastrointestinal lymphoma. For decades, surgery and later on radiation and chemotherapy were regarded as established therapy. Some 30 years ago, the pathogenetic role of Helicobacter pylori infection for the development of gastric MALT-lymphoma became evident. During the following years, the pathogenetic insights were consequently implemented into clinical medicine. This lead to a radical change of the therapeutic approach to these lymphoma. Nowadays, Helicobacter pylori eradication is the internationally established therapy of first choice. It is followed by lymphoma regression in most cases. The long-term prognosis of patients after exclusive eradication therapy is excellent, even if endoscopic and/or histological residuals persist and a watch-and-wait strategy is favored.

The pathogenetic insights und their clinical application implicated a consequent deescalation of therapy of gastric MALT-lymphoma. This review summarizes the single steps of this development and gives a recommendation for the actual management of patients with gastric MALT lymphoma.

Schlüsselwörter

Magen - MALT-Lymphom - Pathogenese - Therapie - Management

Keywords

stomach - MALT lymphoma - pathogenesis - therapy - management


Publication History

Received: 29 July 2021

Accepted after revision: 17 October 2021

Article published online:
24 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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