Long‐term clinical outcome of Helicobacter pylori eradication for gastric mucosa‐associated lymphoid tissue lymphoma with a reference to second‐line treatment

Abstract

BACKGROUNDThe goals of the current study were to elucidate the long‐term outcome of Helicobacter pylori eradication therapy for gastric mucosa‐associated lymphoid tissue (MALT) lymphoma and to clarify the therapeutic efficacy of stomach‐conserving treatments for patients not responding to eradication therapy.METHODSNinety‐six patients with gastric MALT lymphoma, including 17 patients with areas of diffuse large B‐cell lymphoma, were treated by H. pylori eradication. Patients not responding to eradication therapy underwent either a gastrectomy, multiagent chemotherapy, oral monochemotherapy (OMC), or radiotherapy (RT). Predictive factors for the response to eradication therapy, overall survival (OS), and event‐free survival (EFS) were determined by the Kaplan–Meier analysis with the log‐rank test. The efficacy of second‐line treatment was compared between OMC and RT.RESULTSAfter eradication therapy, 62 (65%) patients achieved complete disease remission (CR). Transient histologic disease recurrence was confirmed in 4 (6.5%) of 62 patients with CR during the follow‐up (median, 37.5 months). The OS and EFS probabilities after 5 years were 0.96 and 0.80, respectively. Second‐line treatment was performed in 31 patients; gastrectomy in 4 patients, multiagent chemotherapy in 5 patients, OMC in 12 patients, and RT in 10 patients. There were no differences in the CR rate, OS, EFS, or toxicity between the OMC and RT groups.CONCLUSIONSH. pylori eradication therapy was an effective first‐line treatment for patients with gastric MALT lymphoma, which led to a favorable long‐term outcome. OMC and RT had an equivalent efficacy as a second‐line treatment in nonresponding patients to eradication therapy. Cancer 2005. © 2005 American Cancer Society.

Non-Hodgkin's Lymphoma of Mucosa-Associated Lymphoid Tissue

“…Of note, the presence of the t(11;18) translocation was associated with alkylator resistance in this cohort [90]. A Japanese group has found no difference in outcome between oral monochemotherapy and radiation as second-line therapy in patients who do not respond to eradication therapy [91].…”

Management of Helicobacter pylori Infection

“…In the presence of H. pylori, the ingestion of urea, labeled with either the nonradioactive isotope 13 C or the radioactive isotope 14 C, results in production of labeled CO 2 , which can be quantitated in expired breath (87)(88)(89)(90). Although the amount of radiation in the 14 C UBT is less than daily background radiation exposure (88), the 13 C test is preferred in children and pregnant females (87).…”

“…The expense of the UBT is largely driven by equipment costs and the cost of labeled urea. UBTs using lower dose 13 C, which have recently been found to yield excellent performance characteristics, may in part address this issue (101).…”

Recognition of changes in microvascular and microstructural patterns upon magnifying endoscopy predicted the presence of extranodal gastric MALToma

“…Based on the data from several studies, the long term outcome of gastric MALToma is considered to be favorable. [10][11][12][13] Despite the relatively less aggressive nature, MALToma poses diagnostic challenges to endoscopists. Conventional white light endoscopy failed to differentiate gastric MALToma from other benign conditions like gastric erosion, chronic gastritis and atrophic gastritis.…”