Treatment Approaches Involving Monoclonal Antibodies Like Rituximab for MALT Lymphoma
In the realm of cancer treatment, a significant stride has been made in the management of MALT (mucosa-associated lymphoid tissue) lymphoma, a type of non-Hodgkin lymphoma that originates from B cells. This article aims to provide an insightful look into the current treatment landscape for MALT lymphoma.
Symptoms of MALT lymphoma can vary based on where the lymphoma develops. For localised lymphoma linked to a Helicobacter pylori infection, antibiotics alone can sometimes make the cancer go away completely. However, for advanced cases, a more comprehensive approach is required.
Beyond antibiotics and radiotherapy, current treatment options for advanced MALT lymphoma include systemic therapies such as immunotherapy and chemotherapy. One such combination, recommended by recent ESMO guidelines, is the use of rituximab, a monoclonal antibody targeting CD20 on B cells, in conjunction with the immunomodulatory drug lenalidomide for patients with refractory or relapsed marginal zone lymphoma (MZL), which includes MALT lymphoma.
Emerging immunotherapeutic approaches include bispecific T-cell engager therapies that target CD20 and CD3, such as mosunetuzumab, epcoritamab, and glofitamab. These therapies have shown promising responses, particularly in relapsed/refractory settings. Glofitamab and epcoritamab have recently been approved for use in some countries for later lines of B-cell lymphoma treatment and might be applicable for MALT lymphoma if refractory to other treatments.
Antibody-drug conjugates like loncastuximab tesirine (anti-CD19 linked to cytotoxic agents) have demonstrated efficacy in heavily pretreated B-cell lymphomas, representing another potential option for advanced or relapsed cases.
In selected cases, hematopoietic stem cell transplantation (HSCT)—particularly autologous HSCT—is considered as consolidation therapy for relapsed or refractory B-cell lymphomas, though most recommendations currently focus on follicular lymphoma. Allogeneic HSCT may be an option for later relapse or transformation depending on patient status.
Supportive care, including steroids, plasmapheresis, and immunoglobulin replacement, may be required to manage symptoms or treatment side effects, but these do not directly treat MALT lymphoma.
Side effects of rituximab, a common treatment for MALT lymphoma, can include mild infusion-related reactions, increased risk of infections due to reduced B cell numbers, and an increased rate of neutropenia when used in combination with chemotherapy. Rare side effects include severe infections, such as progressive multifocal leukoencephalopathy (a brain infection) from a weakened immune system.
Research continues to find even better ways to treat people living with MALT lymphoma, offering hope for treatments that are not only more effective but also safer and more tailored to each person's needs. Scientists are exploring ways to combine rituximab with more powerful treatments to improve results, especially for those whose lymphoma does not respond to initial treatment or returns.
Newer therapies for gastric MALT lymphoma are being developed that use specific antibodies to stop the growth of blood vessels, essentially "starving" the cancer by cutting off its "food supply".
Chronic infections, autoimmune diseases, older age, and other factors can increase the risk of developing MALT lymphoma. Non-Gastric MALT lymphoma can develop in the lungs, thyroid glands, salivary glands, eye area tissue (ocular adnexal MALT lymphoma), and other sites.
If you or someone you care about has been diagnosed with MALT lymphoma, talking to your healthcare team about treatment options can help you make the right choices for your health. It's essential to stay informed about the latest advancements in MALT lymphoma treatment to ensure the best possible outcomes.
- The new approach, involving bispecific T-cell engager therapies that target CD20 and CD3 like mosunetuzumab, epcoritamab, and glofitamab, offers promising responses, particularly in relapsed or refractory cases of MALT lymphoma.
- Apart from antibiotics, radiotherapy, and systemic therapies, medication such as loncastuximab tesirine, an antibody-drug conjugate, has demonstrated efficacy in treating advanced or relapsed cases of MALT lymphoma.
- In addition to treatment options like hematopoietic stem cell transplantation (HSCT) for relapsed or refractory B-cell lymphomas, supportive care like steroids, plasmapheresis, and immunoglobulin replacement are used to manage symptoms or treatment side effects, but they do not directly treat MALT lymphoma.
- Scientists are conducting research to find improved ways to treat MALT lymphoma, aiming to develop treatments that are not only more effective but also safer and more tailored to each person's needs, such as combining rituximab with more powerful treatments for those whose lymphoma does not respond to initial treatment or returns.
