Eradication Therapy Is Effective for Helicobacter pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma.

2012

Asano N, Iijima K, Terai S, Jin X, Ara N, Chiba T, Fushiya J, Koike T, Imatani A, Shimosegawa T.

Source

Division of Gastroenterology, Tohoku University Graduate School of Medicine.

Abstract

Mucosa-associated lymphoid tissue (MALT) lymphomas are extra-nodal B-cell lymphomas arising from MALT, and the most commonly affected organ is the stomach. Helicobacter pylori (H. pylori) eradication therapy with proton-pump inhibitors and antibiotics is the first-line therapy for H. pylori-positive gastric MALT lymphomas, but the effectiveness of the therapy for H. pylori-negative gastric MALT lymphomas remains controversial. Hence, we aimed to evaluate the effectiveness of this eradication therapy for H. pylori-negative MALT lymphomas. The H. pylori infection status of 158 gastric MALT lymphomapatients followed in our unit was judged by urea breath test, rapid urease test, histology of the biopsy specimen taken from the stomach during endocopy, and serum antibody against H. pylori. Seventeen patients that were negative for all four tests and did not have gastric mucosal atrophy were treated with antibiotic eradication therapy. The average age at diagnosis was 56.8 years old (range: 36-73 years), and the median follow-up period after H. pylori eradication in all 17 patients was 5.3 years (range: 0.3-12.7 years). Five patients (29.4%) achieved complete remission (CR) by eradication therapy alone. Comparison between the responding and non-responding patients revealed that the patients endoscopically diagnosed to have a single lesion of gastric MALT lymphoma were seen only in the responding group, whereas all non-responding patients had multiple lesions (P < 0.05). In conclusion, H. pylori eradication therapy achieved a favorable CR rate in H. pylori-negative gastric MALT lymphoma patients and could be considered as a first-line therapy, especially for patients with a single lesion.

PubMed

Antibiotics Effective in Treatment of MALT Lymphoma

Antibiotics Effective in Treatment of MALT Lymphoma

Researchers from Taiwan have reported that treatment of Helicobacter pylori (H. pylori) infection with antibiotics is effective against early-stage, low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach as well as high-grade transformed tumors. The details of this study appeared in the September 21, 2005, issue of the Journal of the National Cancer Institute .

Researchers have long known that H. pylori is associated with a certain type of low-grade non-Hodgkin’s lymphoma referred to as MALT lymphoma. MALT lymphoma develops outside of lymph nodes, most commonly in the stomach, salivary glands, lungs, or thyroid. Treatment of H. pylori infection with antibiotics results in complete disappearance of lymphoma in some patients with early-stage MALT lymphoma of the stomach.

In order to further assess the role of antibiotics in the treatment of patients with early-stage MALT lymphoma of the stomach, researchers in Taiwan evaluated two groups of patients. One group had low-grade MALT lymphoma, while the other had high-grade transformed lymphoma.

The patients with high-grade lymphoma had diffuse large B-cell lymphoma (DLBCL) with features of MALT. Some have speculated that DLBCL(MALT) lymphoma is not dependent on H. pylori and will not be affected by antibiotic treatment.

A large majority of both groups of patients were infected with Helicobacter pylori —94% of the patients with low-grade lymphoma and 100% of the patients with high-grade lymphoma.

Patients were treated with two weeks of antibiotics. The antibiotics were highly effective in both groups:

Antibiotics eliminated the H. pylori infection in 97% of the low-grade patients.

H. pylori infection was eliminated in 92% of the high-grade patients.

Among those whose infection was eliminated:

80% of patients with low-grade lymphoma experienced a complete disappearance of detectable lymphoma.

64% of patients with high-grade lymphoma had a complete disappearance of their disease.
None of the patients who were initially negative for H.pylori and none who had persistent infection after antibiotic treatment experienced a complete disappearance of lymphoma. After roughly five years of follow-up, lymphoma recurred in three (13%) of the patients with low-grade lymphoma; none of the patients with high-grade lymphoma had a recurrence.
The researchers conclude that antibiotic treatment of H. pylori infection is effective for both low-grade MALT lymphoma of the stomach as well as DLBCL(MALT). They recommend additional studies to confirm that antibiotics are an appropriate first-line treatment for early stage, H. pylori-positive DLBCL(MALT).

Comments: These are very interesting results and it will be important to confirm these observations in American patients.

Reference: Chen L-T, Lin J-T, Tai JJ et al. Long-term results of anti-Helicobacter pyloritherapy in early-stage gastric high-grade transformed MALT lymphoma. Journal of the National Cancer Institute . 2005;97:1345-1353.

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