From the Research
The Gela criteria for further treatment in gastric marginal zone lymphoma primarily guide decisions after initial Helicobacter pylori eradication therapy, with patients receiving additional treatment if they meet criteria such as persistence of lymphoma at endoscopic evaluation 12 months after H. pylori eradication, progression of disease during follow-up, or H. pylori-negative status at diagnosis, as supported by the most recent study 1.
Key Considerations
- The criteria are crucial for identifying patients who do not respond to H. pylori eradication alone, which occurs in approximately 20-30% of gastric MALT lymphomas 2.
- Timely identification of non-responders allows for appropriate escalation of therapy before disease progression, improving outcomes in terms of morbidity, mortality, and quality of life.
- Treatment selection depends on disease extent, patient age, and comorbidities, with options including rituximab-based immunochemotherapy or radiation therapy 3.
Treatment Options
- Rituximab-based immunochemotherapy, such as R-CHOP, is a recommended treatment for patients meeting the Gela criteria, as it has shown efficacy in achieving complete responses and improving survival 3.
- Radiation therapy, specifically involved field radiation therapy at 24-30 Gy, is another option for patients who meet the criteria, particularly those with localized disease or who are not candidates for immunochemotherapy.
Surveillance and Monitoring
- Regular endoscopic surveillance with biopsies is essential during and after treatment to monitor response and detect any signs of disease progression or recurrence, as emphasized in the study 4.
- This approach allows for timely adjustments to treatment and improves overall patient outcomes by minimizing the risk of complications and maximizing the effectiveness of therapy.