It is known that primary gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) can regress with conservative treatment.
This may include treatments such as anti-Helicobacter pylori therapy or mono-chemotherapy.
In order to assess the effects of adjuvant therapy in responding patients, and to evaluate an alternative therapy in non-responding patients, predictive factors of the response to anti-H. pylori treatment have been analyzed.
From 1995 to 2000, M. Levy and colleagues at the H˘pital Henri Mondor, in Creteil, France, treated 48 patients with anti-H. pylori therapy.
All 48 patients in the study group were previously H. pylori-infected, and had localized primary gastric low-grade B-cell lymphoma MALT.
Endoscopic and endoscopic ultrasonography features and histological grading of large cells' proportion were analyzed.
|Non-responders to anti-H. pylori therapy:|
58% achieved lymphoma remission with chlorambucil
|American Journal of Gastroenterology |
At two months and six months respectively, the efficacy of the H. pylori eradication therapy, and tumoral response, were also assessed.
From 1996, patients in remission at 6 months were randomized to receive either chlorambucil p.o. for 6 months or no treatment.
Patients who did not respond to H. pylori eradication received chlorambucil p.o. for 1 year.
Among the 48 treated patients, 33 (69%) were in complete (n = 28) or in partial (n = 5) remission, and 15 (31%) were in treatment failure at 6 months.
H. pylori was eradicated in 47 patients.
The response was not correlated with the endoscopic features or with the histological grade.
In contrast, it was related to ultrasonographic features: remission was achieved in 76% of patients when no peri-gastric lymph node was detected versus only 33% when endoscopic ultrasonography showed presence of lymph nodes.
All responding patients remained in remission (median 34 months) whatever the treatment they received (no treatment or chlorambucil).
Remission could be achieved with chlorambucil in 58% of the non-responding patients to anti-H. pylori treatment.
Writing in the American Journal of Gastroenterology, the authors say the major negative predictive factor of the tumoral response to anti-H. pylori treatment in these patients was the presence of peri-gastric lymph nodes on endoscopic ultrasonography.
In responding patients remission remained stable, suggesting that adjuvant chemotherapy was not useful.
Concluding, the authors write, "In patients who failed to respond to H. pylori eradication, mono-chemotherapy with chlorambucil proved to be efficient, but new therapeutic modalities should be evaluated to improve the control of the tumoral process."