Long-term results of anti-Helicobacter pylori therapy in early-stage gastric high-grade transformed MALT lymphoma.

Abstract

BACKGROUND:

Several independent clinical studies have reported that Helicobacter pylori eradication therapy could achieve complete remission in some patients with H. pylori-positive early-stage gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

METHODS:

To compare the long-term results of anti-H. pylori therapy in early-stage, gastric low-grade and high-grade transformed MALT lymphoma, two multicenter prospective studies of anti-H. pylori therapy for early-stage gastric lymphoma conducted in Taiwan, one for low-grade MALT lymphoma, with 34 patients enrolled from March 1996 through April 1999, and one for high-grade transformed tumors (diffuse large B-cell lymphoma with features of MALT, DLBCL[MALT] lymphoma), with 24 patients enrolled since June 1995, were directly compared. In both studies, patients generally received 2 weeks of antibiotics and had multiple sequential follow-up endoscopic examinations until complete histologic remission (CR) or disease progression; patients were monitored through January 31, 2004. CR was defined as regression of lymphoid infiltration to Wotherspoon's score of 2 or less on all pathologic sections of endoscopic biopsy specimens. All statistical tests were two-sided.

RESULTS:

The H. pylori-positive rate among the 34 low-grade patients was 94% (32 of 34). All 24 selected high-grade patients were H. pylori positive. H. pylori was eradicated in 97% (30 of 31) of evaluable H. pylori-positive low-grade patients and in 92% (22 of 24) of high-grade patients, which led to CR in 80% (24 of 30, 95% confidence interval [CI] = 65% to 95%) and 64% (14 of 22, 95% CI = 42% to 86%) of patients, respectively. None of the five patients who were either initially H. pylori negative or had persistent H. pylori infection after antibiotics achieved CR. After median follow-up of more than 5 years in complete responders, tumor recurrence was observed in three (13%) low-grade patients but not in high-grade patients.

CONCLUSIONS:

Anti-H. pylori therapy may be considered as one of the treatment options for early-stage H. pylori-positive gastric DLBCL(MALT), and large-scale prospective studies to validate its use as first-line therapy for such tumors should be undertaken.

• Authors: Li-Tzong Chen, Jaw-Town Lin, John Jen Tai, Gran-Hum Chen, Hong-Zen Yeh, Sheng-Shun Yang, Hsiu-Po Wang, Sung-Hsin Kuo, Bor-Shyang Sheu, Chang-Ming Jan, Wen-Ming Wang, Tsang-En Wang, Chew-Wun Wu, Chi-Long Chen, Ih-Jen Su, Jacqueline Whang-Peng, Ann-Lii Cheng
• Journal: Journal of the National Cancer Institute (J Natl Cancer Inst) Vol. 97 Issue 18 Pg. 1345-53 (Sep 21 2005) ISSN: 1460-2105 [Electronic] United States
• PMID: 16174856 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Anti-Ulcer Agents
• Organometallic Compounds
• Metronidazole
• Amoxicillin
• bismuth tripotassium dicitrate
• Omeprazole

Topics

• Adult
• Aged
• Amoxicillin (administration & dosage)
• Anti-Bacterial Agents (administration & dosage)
• Anti-Ulcer Agents (administration & dosage)
• Disease Progression
• Disease-Free Survival
• Drug Administration Schedule
• Female
• Gastroscopy
• Helicobacter Infections (complications, drug therapy)
• Helicobacter pylori (drug effects)
• Humans
• Lymphoma, B-Cell, Marginal Zone (drug therapy, pathology)
• Male
• Metronidazole (administration & dosage)
• Middle Aged
• Multicenter Studies as Topic
• Omeprazole (administration & dosage)
• Organometallic Compounds (administration & dosage)
• Prospective Studies
• Severity of Illness Index
• Stomach Neoplasms (drug therapy, microbiology, pathology)
• Survival Analysis
• Taiwan
• Time Factors
• Treatment Outcome