Long term outcome of patients with gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT) following exclusive Helicobacter pylori eradication therapy: experience from a large prospective series

• Published in: Gut Vol. 53; no. 1; pp. 34 - 37
• Main Authors: Fischbach, W, Goebeler-Kolve, M-E, Dragosics, B, Greiner, A, Stolte, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.01.2004; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; Copyright 2004 by Gut
• Subjects: Abdomen; Adult; Aged; Aged, 80 and over; Amoxicillin - therapeutic use; amoxycillin; and clarithromycin; Anti-Infective Agents - therapeutic use; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Clarithromycin - therapeutic use; Drug Therapy, Combination; endoscopic ultrasound; Endoscopy; eradication therapy; EUS; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter Infections - complications; Helicobacter Infections - drug therapy; Helicobacter pylori; Hematologic and hematopoietic diseases; Human bacterial diseases; Humans; Infections; Infectious diseases; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma; Lymphoma, B-Cell, Marginal Zone - microbiology; Male; MALT; MALT lymphoma; Medical sciences; metronidazole; Metronidazole - therapeutic use; Middle Aged; mucosa associated lymphoid tissue; OAC; OMC; omeprazole; Omeprazole - therapeutic use; Patients; Prospective Studies; Radiation therapy; Stomach; Stomach Neoplasms - microbiology; Studies; Treatment Outcome; Ulcers; Ultrasonic imaging; Human; Stomach; Therapy; Prognosis; Spirillales; Marginal zone lymphoma; Spirillaceae; Malignant hemopathy; Non Hodgkin lymphoma; Eradication; Long term; Chronic; Experience; MALT lymphoma; Treatment; Helicobacter pylori; Lymphoproliferative syndrome; Gastroenterology; Bacteria; β Cell
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.53.1.34

Background:Helicobacter pylori plays a decisive role in the pathogenesis of gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT), and eradication therapy has become a widely accepted initial treatment of stage I disease. Objective: To determine the long term outcome of patients undergoing exclusive H pylori eradication therapy. Design: A prospective series of patients with newly diagnosed marginal zone B cell lymphoma of MALT. Setting: Multicentre study in Germany and Austria. Patients: Ninety five patients; 90 of these (five lost to follow up) with a mean age of 54.3 (27–85) years were followed up for at least 12 months. Intervention: Complete staging work up revealing stage I disease and H pylori infection. Patients received triple therapy (OMC: omeprazole 20 mg twice daily, metronidazole 400 mg twice daily, and clarithromycin 250 mg twice daily; or OAC: omeprazole 20 mg twice daily, amoxycillin 1000 mg twice daily, and clarithromycin 500 twice daily) for one week. Results: Median follow up was 44.6 (12–89) months. H pylori was successfully eradicated in 88 patients (98%); in two patients eradication therapy failed. Long term outcome was characterised by complete regression of lymphoma in 56 patients (62%), minimal residual disease in 17 patients (18%), partial remission in 11 patients (12%), no change in four patients (4%), and progressive disease in two patients (2%). Four patients with complete remission relapsed after 6, 8, 8, and 15 months, one revealing reinfection by H pylori. Regression rate was higher in stage I1 disease compared with stage I2, as diagnosed by endoscopic ultrasound. Conclusion: The majority of patients with low grade gastric MALT lymphoma treated by exclusive H pylori eradication have a favourable long term outcome, offering a real chance of cure.