Kiesewetter B, et al. - Because there is still no definite therapeutic algorithm for MALT lymphoma patients beyond H. pylori eradication and while recent data on chemotherapy based regimens +/- rituximab (R) have potentially set new standards for patients in need of systemic treatment, researchers studied chemotherapy-free strategies in this retrospective study. Participants in the study were all patients with histologically verified MALT lymphoma treated at the Medical University Vienna 1999-2019 and identified patients receiving first line systemic treatment defined as either chemotherapy (=classical cytostatic agents +/- R) or immunotherapy (=immunomodulatory agents or anti-CD20 antibodies). In total, 159 subjects received upfront systemic treatment (median age 65 years, female-male ratio 1.3) with the median follow-up being 66 months (IQR 33-101). The data exhibited higher chemotherapy response rates vs immunotherapy, but this did not translate into superior progression-free survival. Therefore, given the biological background of MALT lymphoma as a disease, it is highly dependent on the microenvironment, and given the favorable toxicity profile of novel immunotherapy approaches such as IMiDs and macrolides, the authors suggest that chemo-free systemic treatment is active and should be further examined in clinical trials.