Long-term persistence of molecular disease after histological remission in low-grade gastric MALT lymphoma treated with H. pylori eradication. Lack of association with translocation t(11;18): a 10-year updated follow-up of a prospective study.
BACKGROUND
Localized low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma can regress after Helicobacter pylori eradication, but IgV(H) gene monoclonality may persist. We studied the long-term histological and molecular follow-up of 24 patients and the possible association of t(11;18) with the persistent monoclonality.


METHODS
From January 1994, 24 untreated patients with stage I low-grade gastric MALT lymphoma associated with H. pylori were prospectively studied. They all received eradication treatment and were sequentially followed-up with endoscopies for histological and molecular studies. Rearrangement of the IgV(H) gene was studied by PCR analysis. MALT1 locus alterations were studied by FISH.


RESULTS
Twenty-two of the 24 patients (91%) achieved disappearance of the lymphoma. Eighteen (82%) of the 22 histologically cured patients and 16 of the 19 (84%) with long follow-up had monoclonality. Three patterns of development of IgV(H) gene rearrangements were observed: four patients (21%) had polyclonal rearrangements; eight (58%) had maintained/intermittent monoclonality and four (21%) had occasional monoclonality, mostly after H. pylori reinfection. Only one patient (6%) with persistent monoclonality relapsed. The remaining 18 patients maintained the remission, despite the persistent monoclonality in 15, for a median of 66 months (range 20-113). t(11;18) was not found in any of the patients with persistent monoclonality. Time and the number of endoscopies performed were not related with the occurrence of monoclonality.


CONCLUSIONS
In stage I low-grade gastric MALT lymphoma eradication of H. pylori achieves prolonged histological remission in 90% of patients, but molecular remission is not accomplished in most cases. Molecular disease persists for years, but is not associated with t(11;18).
Montalban
C
C
Department of Internal Medicine, Hospital Ramón y Cajal, Madrid, Spain. cmontalban.hrc@salud.madrid.org
Santón
A
A
Redondo
C
C
García-Cosio
M
M
Boixeda
D
D
Vazquez-Sequeiros
E
E
Norman
F
F
de Argila
C M
CM
Alvarez
I
I
Abraira
V
V
Bellas
C
C
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002880:Chromosomes, Human, Pair 11; D002887:Chromosomes, Human, Pair 18; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy* / Q000235:genetics* / Q000382:microbiology; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000382:microbiology; D014178:Translocation, Genetic
D000900:Anti-Bacterial Agents