Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicentre cohort follow-up study of 420 patients in Japan.

Apr 2012

Nakamura S, Sugiyama T, Matsumoto T, Iijima K, Ono S, Tajika M, Tari A, Kitadai Y, Matsumoto H, Nagaya T, Kamoshida T, Watanabe N, Chiba T, Origasa H, Asaka M; JAPAN GAST Study Group.

Collaborators (23)

Source

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. shonaka@intmed2.med.kyushu-u.ac.jp

Abstract

OBJECTIVE:

A multicentre cohort follow-up study of a large number of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma was conducted to elucidate the long-term outcome of the disease after Helicobacter pylori eradication.

METHODS:

420 patients with gastric low-grade MALT lymphoma who had undergone successful H pylori eradication and been followed up for at least 3 years were registered from 21 participating institutes. Responders to treatment were defined as patients whose post-treatment biopsies showed complete histological response (ChR) or probable minimal residual disease (pMRD). Treatment failure was defined as the status of progressive disease or lymphoma relapse after ChR/pMRD.

RESULTS:

323 patients (77%) responded to H pylori eradication. A logistic regression analysis showed that absence of H pylori, submucosal invasion determined by endoscopic ultrasonography and t(11;18)/API2-MALT1 were independent predictors of resistance to H pylori eradication. During the follow-up periods ranging from 3.0 to 14.6 years (mean 6.5 years, median 6.04 years), the disease relapsed in 10 of 323 responders (3.1%) while progressive disease was found in 27 of 97 non-responders (27%). Thus, 37 of 420 patients (8.8%) were regarded as treatment failures. Of these 37 patients, transformation into diffuse large B cell lymphoma occurred in nine patients. Among the non-responders and relapsed patients, 17 patients were subjected to a 'watch and wait' strategy while 90 patients underwent second-line treatments including radiotherapy (n=49), chemotherapy (n=26), surgical resection (n=6), chemoradiotherapy (n=5), antibiotic treatment (n=2), rituximab monotherapy (n=1) or endoscopic resection (n=1). Probabilities of freedom from treatment failure, overall survival and event-free survival after 10 years were 90%, 95% and 86%, respectively. Cox multivariate analysis revealed endoscopic non-superficial type to be an independent prognostic factor for adverse freedom from treatment failure, overall survival and event-free survival.

CONCLUSIONS:

The excellent long-term outcome of gastric MALT lymphoma after H pylori eradication was confirmed by this large-scale follow-up study.

GUT Int. Journal of Gastroenterology and Hepatology

Research Progress on the Etiology and Pathogenesis of MALT Lymphoma

2012 

[Article in Chinese]

Wang XC, Ke XY.

Source

Department of Hematology, Peking University Third Hospita, Beijing 100083, China.

Abstract

Mucosa-associated lymphoid tissue (MALT) lymphoma originated outside the lymph nodes is low grade malignant B celllymphoma. It is the most frequent type of marginal zone non-Hodgkin's lymphoma, that usually occurs in the stomach, salivary gland, thyroid gland and orbital adnexa. Gastric MALT lymphoma accounts for 50% of MALT lymphoma. GastricMALT lymphoma has been confirmed to relate with Helicobacter pylori (HP) infection, its main pathogenesis is immune reaction, but some patients with chromosome translocation have no response to HP eradication, suggesting presence of other unknow pathogenesis. The chromosome translocations in MALT lymphoma are t(11;18)(q21;q21), t(1;14)(p22;q32), t(14;18)(q32;q21), t(3;14)(p14.1;q32). Recent studies show some new chromosomal abnormalities such as 6q23.3/A20 and so on, which have some effects on clinical course and prognosis. MALT lymphoma with chromosome abnormalities usually activate common NF-κB molecular pathway, and persistent active NF-κB pathway drives tumor cell proliferative and active, resulting in lymphoma incidence. In this articl, the advances in the etiology and pathogenesis of MALT lymphoma were reviewed.

PubMed

The many faces of marginal zone lymphoma.

2012

Zinzani PL.

Source

1Istituto di Ematologia "Seràgnoli" Università di Bologna, Bologna, Italy.

Abstract

Indolent B-cell lymphomas that are supposed to derive from the marginal zone (marginal zone lymphomas [MZLs]) include 3 specific entities: extranodal marginal zone lymphoma (EMZL) or mucosa-associated lymphatic tissue (MALT) lymphoma, splenic MZL (SMZL), and nodal MZL (NMZL). The clinical and molecular characteristics are different for each entity, with some shared phenotypic and genetic features. EMZL is the most common entity, accounting for approximately 70% of all MZLs. These neoplasms can arise at virtually any extranodal site and are commonly associated with chronic antigenic stimulation either as a result of infection (eg, Helicobacter pylori in the stomach) or autoimmune disease (eg, Sjögren syndrome and salivary glands). Several chromosomal translocations were also identified in EMZL, accounting in the aggregate for approximately one-third of all cases. SMZL accounts for approximately 20% of all MZLs. Patients typically present with an enlarged spleen and involvement of abdominal lymph nodes and BM. Approximately 40%-50% of SMZLs are associated with deletions of chromosome 7q. NMZL is the less common entity, representing approximately 10% of all MZLs. Patients with NMZL, by definition, have lymph node-based disease without involvement of the spleen or extranodal sites. The molecular pathogenesis of NMZL is still unknown.

Hematology

Simultaneous primary gastric and duodenal MALT lymphoma presenting with gastrointestinal bleeding.

Jul 2012

Zippi M, Pica R, Scialpi R, Paoluzi P, Occhigrossi G.

Source

Units of Gastroenterology and Digestive Endoscopy, Pathologic Anatomy, Sandro Pertini Hospital; Unit of Gastroenterology, Sapienza University, Rome, Italy.

Abstract

The gastrointestinal tract, particularly the stomach, is the most common site of mucosa-associated lymphoid tissue lymphoma (MALToma). Many studies describe primary MALT lymphoma arising from the gastric mucosa, especially in association with Helicobacter pylori infection. On the contrary, primary MALT duodenal lymphoma is a very rare neoplasm. We report a case of a patient with gastrointestinal bleeding in whom primary gastric and duodenal MALT lymphoma were occurred simultaneously.

Complete Text La Clinica Terapeutica

PubMed

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

Lack of association of conjunctival MALT lymphoma with Chlamydiae or Helicobacter pylori in a cohort of Chinese patients.

Feb 2012

Cai JP, Cheng JW, Ma XY, Li YZ, Li Y, Huang X, Wei RL.

Source

Department of Ophthalmology, Shanghai Changzheng Hospital, 2nd Military Medical University, Shanghai, China.

Abstract

Background:

This study was conducted to detect microbial pathogens in conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma specimens in an attempt to determine possible associations between conjunctival MALT lymphoma and microbial infections.

Material/Methods:

Using PCR technique, freshly obtained tumor specimens from 16 cases of conjunctival MALT lymphoma, as confirmed by postoperative pathology, were analyzed for DNA of Chlamydia psittaci (C. psittaci), Chlamydia trachomatis (C. trachomatis), Chlamydia pneumoniae (C. pneumoniae) and Helicobacter pylori (H. pylori). Synthetic C. psittaci, C. trachomatis, C. pneumoniae and H. pylori DNA were used as positive control, and blank plasmid DNA as negative control.

Results:

Electrophoresis showed that no bands corresponding to the positive control were observed in the specimens, indicating that no DNA of the 4 microorganisms was detected in the specimens of the 16 cases of conjunctival MALT lymphoma.

Conclusions:

The PCR technique was able to detect the positive control quickly and accurately, but the results of PCR in analyzing the 16 specimens were negative, indicating that there is no association between conjunctival MALT lymphoma and the 4 microorganisms in Chinese patients.

PubMed

What is gastric MALT lymphoma?

What is gastric MALT lymphoma?
Gastric MALT lymphoma is a type of Non Hodgkin Lymphoma (NHL) affecting the stomach

Treatment options for gastric MALT lymphoma:

The following treatments can be used for gastric MALT lymphomas:
Treatment of Helicobacter pylori infection
Radiation therapy
Surgery
Chemotherapy

Let us look at how these different treatments fit in.

Treatment of H pylori infection:

Many cases of MALT lymphoma of the stomach are strongly associated with infection with H pylori, a bacterium that commonly causes gastritis and stomach ulcers. It has been seen that in those patients with MALT lymphoma who also test positive for H pylori, antibiotics for H pylori may actually control the cancer. In 3 out of 4 patients with early disease, H pylori treatment may result in a complete resolution of the tumor. The disease remains controlled in many patients. Those with complete response may be kept on regular follow-up with endoscopies. Cancer treatment may be kept in reserve for later.

Radiotherapy for MALT lymphoma:

Radiation is the preferred treatment for MALT lymphoma when H pylori is absent, or when anti H pylori treatment fails. Relatively low doses of radiation are given, and these doses nearly always control the lymphoma. Radiotherapy treatment alone can cause complete response in more than 95% of the patients, and most patients remain controlled in the long term.

Surgery for MALT lymphoma of the stomach:

Surgery is an effective treatment of MALT lymphomas of the stomach and results in long term control in most patients. The potential morbidities of surgery are higher than those of radiation, and therefore surgery is less commonly used for treatment. Like radiotherapy, surgery is usually sufficient to control and cure MALT lymphomas that are limited to the stomach.

Chemotherapy for MALT lymphoma:

Chemotherapy is generally used for early stage gstric MALT lymphomas when local teatments fail to control disease or when the disease recurs. For advanced stage lesions chemotherapy is the treatment of choice. Different combination treatments are effective in these slow growing lymphomas.

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