High-grade mucosa-associated lymphoid tissue (MALT) lymphomas of the stomach are generally believed to be Helicobacter pylori-independent, autonomously growing tumors.
However, anecdotal cases of regression of high-grade lymphomas after the cure of H. pylori infection have been described.
A prospective study conducted by members of several university hospitals in Taiwan has therefore been carried out to evaluate the effect of anti-H. pylori therapy in Stage IE high-grade gastric MALT lymphomas.
A total of 16 patients with H. pylori infection and stage IE gastric high-grade MALT lymphoma consented to a brief antibiotic therapy as first-line treatment, from June 1995 to April 2000.
Following H. pylori eradication, patients underwent intensive endoscopic follow-up examinations, (either with, or without, endoscopic ultrasonography) with biopsy to evaluate tumor response.
|H. pylori eradication and tumor regression occurred in 10 patients.
| Journal of Clinical Oncology |
Patients with significant improvement of gross lesions that accompanied regression of large cells were followed up without additional treatment.
Patients without significant improvement were immediately referred to systemic chemotherapy.
Eradication of H. pylori was achieved in 15 patients, and was accompanied by rapid gross tumor regression and disappearance of large cells in 10 patients.
All 10 of these patients with early response had subsequent complete histologic remission of lymphoma, with a complete remission rate of nearly 63% being observed.
The response rate was not affected by the tumor grading (proportion of large blast cells within the tumor), but was adversely affected by the depth of tumor invasion.
At a median follow-up of 43.5 months (range, 21.1 to 67.4 months), all 10 of these patients remained lymphoma-free. The median duration of complete response was 31.2 months (range, 14.4 to 49.1 months).
The authors conclude their report by saying that their findings suggest high-grade transformation is not necessarily associated with the loss of H pylori dependence in early-stage MALT lymphomas of the stomach.