MALT lymphoma
MALT lymphoma is a slow-growing type of non-Hodgkin lymphoma (NHL). It is also called extranodal marginal zone lymphoma.
What is MALT lymphoma?
MALT lymphoma is a rare type of blood cancer.
It develops when blood cells called lymphocytes become abnormal. These blood cells normally help fight infection.
The abnormal lymphocytes build up in areas called mucosa-associated lymphoid tissue (MALT). Mucosa is the name for the tissue that lines some organs in the body. This means that MALT lymphoma may start in various parts of the body. The most common area for it to develop is the stomach. This is called gastric MALT lymphoma.
MALT can start in other areas, including the:
- lung
- skin
- thyroid gland
- salivary gland
- bowel
- eye.
Other types of marginal zone lymphoma
MALT is 1 of 3 types of marginal zone lymphoma. The other 2 types are:
- nodal marginal zone lymphoma (NMZL)
- splenic marginal zone lymphoma (SMZL).
If you are still having tests or waiting for a clear diagnosis, your doctor may talk to you about all 3 types.
Related pages
Booklets and resources
Symptoms of MALT lymphoma
The symptoms of MALT depend on where in the body it started. You may have no symptoms at all.
For example, MALT lymphoma in the stomach may cause symptoms such as:
- indigestion
- pain in the tummy (abdomen)
- loss of appetite
- feeling sick (nausea).
MALT lymphoma in the lung may cause symptoms such as:
- a persistent cough
- breathlessness.
B symptoms
MALT lymphoma may also cause the following symptoms:
- drenching night sweats
- unexplained weight loss.
These are called B symptoms. Along with staging and grading (below), B symptoms can help your cancer team understand:
- how the lymphoma might develop
- which treatments might help.
Worried about symptoms?
A change in how you feel or how your body works can be caused by conditions other than MALT lymphoma. But always ask your GP to check any ongoing, new or unexplained symptoms.
We are also here if you need someone to talk to. You can:
- call the Macmillan Support Line free on 0808 808 00 00, 7 days a week 8am to 8pm.
- chat to our specialists online.
Related pages
Causes of MALT lymphoma
MALT lymphoma is often caused by long term inflammation. This may be because of an infection or autoimmune condition in the affected area.
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Infection
Most MALT lymphomas that develop in the stomach can be linked to an infection called helicobacter pylori (H. pylori). If H. pylori infection is not treated, it can cause long term inflammation of the stomach lining. Over time, this may cause MALT lymphoma to develop.
MALT lymphoma in other parts of the body, such as the skin, eyes or bowel, may also be linked to infections. But this link is less clear.
Long term infection with the hepatitis C virus (HCV) is also a risk factor for MALT lymphoma.
It is important to remember that most people with these infections will not develop lymphoma.
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Autoimmune conditions
Most MALT lymphomas that develop in the thyroid or salivary glands can be linked to autoimmune conditions. These include Hashimoto’s thyroiditis and Sjögren’s syndrome. Autoimmune diseases develop when the immune system attacks healthy body tissue by mistake.
- In Hashimoto’s thyroiditis, the immune system attacks the thyroid gland, making it less active. This affects the level of hormones it produces.
- In Sjögren’s syndrome, the immune system attacks glands that make tears and saliva. This causes dry eyes and a dry mouth.
MALT lymphoma can affect people of all ages. But it is more common around the age of 70.
Like other cancers, MALT lymphoma is not infectious. You cannot spread it to other people.
Diagnosis of MALT lymphoma
If you have symptoms that worry you, you should start by going to your GP. They may arrange for you to have blood tests or scans. If they think cancer may be causing your symptoms, they will refer you to a hospital for tests and for specialist advice and treatment.
At the hospital, the doctor will ask about any symptoms, your general health and any illnesses you have had. They will also examine you. The most important test for diagnosing MALT lymphoma is a biopsy. This means testing a small piece of tissue or a sample of cells from an area of the body affected.
The type of biopsy you have will depend on where the lymphoma has developed. For example, you may have:
- an upper GI endoscopy to examine and take samples (biopsies) from different areas of the stomach
- a bronchoscopy to examine and take biopsies from the lungs.
You can read more about the tests you may have in our general general lymphoma information.
Waiting for test results
Waiting for test results can be a difficult time. It may take up to 2 weeks for the results to be ready.
You may find it helpful to talk to family members or a close friend. Your specialist nurse can also provide support.
You can talk to one of our cancer support specialists for free on 0808 808 0000, 7 days a week, 8am to 8pm.
Related pages
Booklets and resources
Staging and grading of MALT lymphoma
Your test results give your cancer team more information about the lymphoma. This includes:
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The stage
Staging describes how many areas of your body are affected by lymphoma and where these areas are. In MALT lymphoma of the stomach, doctors also measure how far the lymphoma has spread from the lining of the stomach into the deeper layers of the stomach.
MALT lymphoma is usually stage 1 or stage 2 (early stage) at diagnosis.
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The grade
Grading describes how and how quickly the lymphoma cells are likely to grow. MALT lymphoma is low grade lymphoma. This means it usually develops slowly. Rarely, it can change (transform) into high grade lymphoma. High grade lymphoma grows more quickly and needs treatment straight away.
Knowing the stage and grade of the lymphoma helps your cancer team plan the right treatment for you.
We have more information about staging and grading non-Hodgkin lymphoma.
Treatment for MALT lymphoma
A team of specialists will meet to discuss the best possible treatment for you. They are called a multidisciplinary team (MDT).
After the MDT meeting, you will usually meet with your cancer doctor and specialist nurse. They will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.
Treatment for MALT lymphoma depends on:
- the stage of the lymphoma
- whether it is linked to an infection
- whether you have symptoms that are causing problems
- if you have had treatment before.
MALT lymphoma usually develops slowly. If you have no symptoms, you may not need any treatment. Instead, you may have regular tests and appointments to monitor the lymphoma and check for signs that you need to start treatment. This is called watch and wait. It may also be called active surveillance or active monitoring. It is a way of safely delaying treatment until you need it.
If you need to start treatment, it may include one of the following. You may have some treatments as part of a clinical trial.
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Treating infections
You may have tests and treatment for any infections linked to MALT lymphoma. Treating infection may make all signs of the lymphoma disappear. This is called remission. But it may take several months.
If you have MALT lymphoma in the stomach, the treatment is called triple therapy. It involves taking 2 types of antibiotics and a treatment to reduce the amount of acid the stomach makes. After triple therapy, you will have another endoscopy test. This helps your cancer team check the lymphoma is shrinking and whether you need further treatment.
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Cancer drug treatment
Cancer drug treatment may be used to treat MALT lymphoma that has spread or is causing symptoms. You usually have the immunotherapy drug rituximab in combination with chemotherapy. Commonly used combinations include:
- rituximab with chlorambucil
- rituximab with bendamustine
- R-CVP.
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Radiotherapy
Radiotherapy uses high-energy rays called radiation to treat cancer. It destroys cancer cells in the area you have it.
It may be used to treat MALT lymphoma in parts of the body such as the eye, thyroid gland or stomach if the lymphoma:
- is only in that area and has not spread to other parts of the body
- is not caused by H. pylori infection
- has not got better by treating infection.
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Surgery
If the MALT lymphoma is very small and not in your stomach, the doctor may be able to remove it during a biopsy.
Treating MALT lymphoma relapse
Treatment for MALT lymphoma is often very effective. It may make all signs of lymphoma disappear for a time. Some people will not need further treatment for many years. But MALT lymphoma often comes back. This is called recurrence or relapse.
If you have a relapse with no symptoms, you may have ongoing monitoring with tests and scans. If you need to start treatment, it may involve the following:
- radiotherapy to treat an area of lymphoma that is causing symptoms
- rituximab
- rituximab with chemotherapy
- intensive treatment with a stem cell transplant
- targeted therapy drugs, such as zanubrutinib.
Your cancer team will talk to you about the best options for your situation.
Treating transformed MALT lymphoma
Sometimes MALT lymphoma can change from low grade into high grade lymphoma. This is called transformation or transformed MALT lymphoma. It is not common. But your cancer team will do tests to check for this when you are diagnosed or have a relapse of MALT lymphoma.
High grade lymphoma grows more quickly. It is treated differently. Transformed MALT lymphoma is treated in the same way as another type of lymphoma called DLBCL.
After MALT lymphoma treatment
Follow-up after treatment for MALT lymphoma
You will have regular check-ups during and after your treatment. Your cancer doctor or specialist nurse will explain what to expect.
Follow-up appointments are a good time to talk to your cancer doctor or specialist nurse about any concerns you have. Tell them as soon as possible if you have any problems or notice new symptoms between appointments. We have more information about follow-up care after treatment.
Sometimes side effects may continue or develop months or years after treatment. These are called late effects. We have more information about late effects of lymphoma treatment.
Wellbeing and recovery
Taking good care of yourself can help speed up your recovery after MALT lymphoma treatment. Even small lifestyle changes may improve your wellbeing and long term health.
Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information on leading a healthy lifestyle after treatment.
Support for people with MALT lymphoma
People often have many different feelings during and after MALT treatment. If you have finished treatment, you may feel relieved it has ended but worried about what might happen in the future.
It is important to know where to get support or information if you need it. People often need support even some time after MALT treatment. But sometimes it is difficult to know who to ask for help.
You can:
- ask your GP or someone from your cancer team for advice about support in your area
- find cancer support services near you
- call the Macmillan Support Line for free on 0808 808 00 00.
- chat to our cancer information specialists online.
- visit our non-Hodgkin lymphoma forum to talk to people who have been affected by lymphoma, share your experience, and ask your questions.
You may also find the HOPE programme helpful. The programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer. Topics include goal setting, fatigue management, and wellbeing.
You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk
Other organisations who offer information and support
- Blood Cancer UK offers support and information to people affected by blood cancers, including lymphoma.
- Lymphoma Action provides high quality information and support for people affected by lymphoma. It provides helpline services and a range of peer support including online support meetings, educational events and webinars. Its website includes TrialsLink, a database of lymphoma clinical trials.
More information and advice
We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our lymphoma information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Cwynarski K, Marzolini MAV, Barrington SF, et al. The management of primary mediastinal B-cell lymphoma: a British Society for Haematology Good Practice Paper. Br J Haematol. 2019;185:402-9.
Eyre TA, Bishton MJ, McCulloch R, et al. Diagnosis and management of mantle cell lymphoma: A British Society for Haematology Guideline. Br J Haematol. 2024;204(1):108–26.
Ferreri AJM, Illerhaus G, Doorduijn K, et al., on behalf of the EHA and ESMO Guidelines Committees. Primary central nervous system lymphomas: EHA–ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(6):491-507.
Fox CP, Ahearne MJ, Pettengell R, et al. Guidelines for the management of mature T- and natural killer-cell lymphomas (excluding cutaneous T-cell lymphoma): a British Society for Haematology Guideline. Br J Haematol. 2022;196:507-22.
Fox CP, Chaganti S, McIlroy G, et al. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol. 2024;204(4):1178–92.
McNamara C, Montoto S, Eyre TA, et al. The investigation and management of follicular lymphoma. Br J Haematol. 2020;191:363-81.
Pratt G, El-Sharkawi D, Kothari J, et al. Diagnosis and management of Waldenström macroglobulinaemia—A British Society for Haematology guideline. Br J Haematol. 2022;197:171–87.
Walewska R, Eyre TA, Barrington S, et al. Guideline for the diagnosis and management of marginal zone lymphomas: A British Society of Haematology Guideline. Br J Haematol. 2024;204(1):86–107.
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