通常,低度恶性MALT 淋巴瘤的前景良好。
不良预后因素
包括诊断时机能状态较差、存在 t(11;18) 细胞遗传学异常,以及向高度恶性肿瘤的转化。t(11;18) 异常与对幽门螺杆菌根除治疗反应不良、幽门螺杆菌-阴性 MALT 肿瘤以及晚期高发病率相关。
早期幽门螺杆菌-阳性 MALT 淋巴瘤
单独的抗生素治疗可在 60%-100% 的患者中诱导长期缓解。[62]Bertoni F, Conconi A, Capella C, et al. Molecular follow-up in gastric mucosa-associated lymphoid tissue lymphomas: early analysis of the LY03 cooperative trial. Blood. 2002;99:2541-2544.http://bloodjournal.hematologylibrary.org/cgi/content/full/99/7/2541http://www.ncbi.nlm.nih.gov/pubmed/11895791?tool=bestpractice.comI 期淋巴瘤患者的缓解率明显高于 II 期淋巴瘤患者(78.4% vs 55.6%),亚洲人的缓解率明显高于白人(84.1% vs 73.8%),局限于远端胃部淋巴瘤的缓解率明显高于近端胃部淋巴瘤 (91.8% vs 75.7%)。[63]Zullo A, Hassan C, Cristofari F,et al. Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol. 2010;8:105-110.http://www.ncbi.nlm.nih.gov/pubmed/19631287?tool=bestpractice.com此外,未检测到 AP12-MALT1 易位的患者的缓解率更高。[63]Zullo A, Hassan C, Cristofari F,et al. Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol. 2010;8:105-110.http://www.ncbi.nlm.nih.gov/pubmed/19631287?tool=bestpractice.com达到完全缓解所需的时间长度从 3 个月到 1 年以上不等。[64]Zucca E, Cavalli F. Are antibiotics the treatment of choice for gastric lymphoma? Curr Hematol Rep. 2004;3:11-16.http://www.ncbi.nlm.nih.gov/pubmed/14695844?tool=bestpractice.com
晚期或幽门螺杆菌-阴性 MALT 淋巴瘤
通常对抗生素耐药。90% 的疾病局限于胃部的病例可取得完全反应,5 年无疾病生存率与总生存率分别为 98% 和 77%。[46]Tsang RW, Gospodarowicz MK, Pintilie M, et al. Localized mucosa-associated lymphoid tissue lymphoma treated with radiation therapy has excellent clinical outcome. J Clin Oncol. 2003;21:4157-4164.http://www.ncbi.nlm.nih.gov/pubmed/14615444?tool=bestpractice.com
在播散性疾病中,75% 用烷化剂或嘌呤类似物治疗的病例可取得完全反应。[65]Thieblemont C. Clinical presentation and management of marginal zone lymphomas. Hematology Am Soc Hematol Educ Program. 2005:307-313.http://asheducationbook.hematologylibrary.org/cgi/content/full/2005/1/307http://www.ncbi.nlm.nih.gov/pubmed/16304396?tool=bestpractice.com