Mucosa-associated lymphoid tissue lymphoma of the stomach

Abstract

BACKGROUND.Although antibiotic therapy is emerging as effective initial treatment for patients with gastric lymphoma of mucosa-associated lymphoid tissue (MALT), there is a subset of patients for whom antibiotics are ineffective or inappropriate. Surgical resection can be curative, but total gastrectomy may be required for the eradication of all disease. To identify the optimal nonantibiotic therapy for early stage gastric MALT lymphoma, the authors retrospectively evaluated the Massachusetts General Hospital experience with gastric MALT lymphoma. METHODS.Disease patterns and treatment outcomes were retrospectively analyzed in data from 21 consecutive patients with gastric MALT lymphoma who were treated between 1978 and 1995 at the Massachusetts General Hospital. RESULTS.Sixteen patients were Stage IE, and 5 were in higher stages. Treatment consisted of resection with or without radiation or chemotherapy (14 patients), radiation alone (4 patients), or radiation plus chemotherapy (2 patients). Thirteen Stage IE patients received local therapy only. The 10-year actuarial relapse free survival rate for Stage IE patients was 93%, with 1 relapse among 15 treated patients. Because the patient who relapsed was treated successfully with chemotherapy, the 10-year cancer free survival was 100%. Overall survival for Stage IE patients was 93% at 5 years and 58% at 10 years, with no deaths from lymphoma. CONCLUSIONS.These data indicate that a high probability of long term remission can be achieved with only local treatment of patients with Stage I gastric MALT lymphoma. Preliminary results suggest that radiation therapy is well tolerated and effective and may well be the optimal nonantibiotic treatment for patients with localized gastric MALT lymphoma.

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

“…Although the risk for second malignancies is low [84], this cannot be neglected, especially in patients who may already have an increased incidence of gastric cancer, because of the link between H. pylori infection and the development of gastric adenocarcinoma [85,86]. Remission with chemotherapy has been described in a patient who relapsed following partial gastrectomy and postoperative radiation [87].…”

Curative resection plus adjuvant chemotherapy for early stage primary gastric non-Hodgkin's lymphoma: a retrospective study with emphasis on prognostic factors and treatment outcome

“…Helicobacter pylori (H. pylori) infection has been documented in up to 90% of patients with low-grade MALT lymphoma (11,18,22) . The discovery of a causative role for H. pylori in the development of gastric marginal zone lymphoma of the MALT type has dramatically altered the therapeutic approach to patients with early stage disease.…”

“…Durable complete remission might be achieved in up to 80% in patients with early stage MALT lymphoma following eradication of the bacteria (11,18) . Conservative anti-H. pylori therapy may regress early-stage gastric lymphoma to some degree, but not completely (11) . The effect is considered insufficient in the case of lymphoma invasion beyond the submucosa of the stomach and a pretreatment diagnosis of the depth of lymphoma invasion is difficult (18) .…”

“…Besides which, the duration of this response remains unknown and long-term follow-up studies are needed for cases treated without surgery. Radiotherapy, chemotherapy or surgery has been tried in patients that failed to respond to H. pylori eradication, or that had a low grade of gastric MALT lymphoma without H. pylori infection (11,15,18) . In most series, the poor prognostic factors for primary gastric lymphoma are considered to be high histological grade, involvement of lymph nodes, incomplete extirpation of the neoplasm, primary lesion greater than 10 cm in diameter and invasion of the serous membrane or adjacent organs (1,2,4,33) .…”

“…The discovery of a causative role for H. pylori in the development of gastric marginal zone lymphoma of the MALT type has dramatically altered the therapeutic approach to patients with early stage disease. Durable complete remission might be achieved in up to 80% in patients with early stage MALT lymphoma following eradication of the bacteria (11,18) . Conservative anti-H. pylori therapy may regress early-stage gastric lymphoma to some degree, but not completely (11) .…”