title: Relapse of low-grade gastric MALT lymphoma after Helicobacter pylori eradication: true relapse or persistence? Long-term post-treatment follow-up of a multicenter trial in the north-east of Italy and evaluation of the diagnostic protocol's adequacy.
abstract: The effect of eradication of Helicobacter pylori on early stage gastric low-grade MALT lymphoma in 76 patients with follow-up of at least 1 year (12-63 months, mean 28) is reported. No regression was found in five cases after 12-48 months. In one case surgical resection detected the involvement of perigastric lymph nodes overlooked by endoscopic ultrasonography (EUS). Neither progression of the disease nor a high-grade component was documented by repeated gastric mappings, EUS and complete stagings in the other four cases. After histological remission five relapses of low-grade and one relapse of high-grade MALT lymphoma were found 12-48 months after eradication. Subsequent histological remission, without any additional therapy, was found in three relapsed cases. A rapid and persistent histological remission was obtained in 56 patients (73%). A late remission was observed in six cases. Monoclonal remission was found in half of the patients and was frequently delayed. Persistent monoclonality was associated with histological remission in the vast majority of patients. Our data confirm H. pylori eradication as the first choice therapy for early stage gastric low-grade MALT lymphoma and recommend extensive bioptic mapping and endoscopic sonography both in the local staging and in the regression evaluation. The rare cases of late remission encourage us to wait for at least 1 year after eradication of H. pylori. Longer follow-up studies will clarify the meaning of histological relapse/persistence and late remission. The study of non-responder cases could show us a step in lymphomagenesis.
authors.affiliation: Department of Histopathology, Ospedale S. Orsola FBF, Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Savio
authors.forename: G
authors.initials: G
authors.lastname: Zamboni
authors.forename: P
authors.initials: P
authors.lastname: Capelli
authors.forename: R
authors.initials: R
authors.lastname: Negrini
authors.forename: G
authors.initials: G
authors.lastname: Santandrea
authors.forename: A
authors.initials: A
authors.lastname: Scarpa
authors.forename: A
authors.initials: A
authors.lastname: Fuini
authors.forename: F
authors.initials: F
authors.lastname: Pasini
authors.forename: A
authors.initials: A
authors.lastname: Ambrosetti
authors.forename: A
authors.initials: A
authors.lastname: Paterlini
authors.forename: F
authors.initials: F
authors.lastname: Buffoli
authors.forename: G P
authors.initials: GP
authors.lastname: Angelini
authors.forename: P
authors.initials: P
authors.lastname: Cesari
authors.forename: F
authors.initials: F
authors.lastname: Rolfi
authors.forename: M
authors.initials: M
authors.lastname: Graffeo
authors.forename: A
authors.initials: A
authors.lastname: Pascarella
authors.forename: M
authors.initials: M
authors.lastname: Valli
authors.forename: A
authors.initials: A
authors.lastname: Mombello
authors.forename: A
authors.initials: A
authors.lastname: Ederle
authors.forename: G
authors.initials: G
authors.lastname: Franzin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005069:Evaluation Studies as Topic; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007558:Italy; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents