Long-term results of anti-Helicobacter pylori therapy in early-stage gastric high-grade transformed MALT lymphoma.
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.
Chen
Li-Tzong
LT
Division of Cancer Research, National Health Research Institutes, Taipei, Taiwan. leochen@nhri.org.tw
Lin
Jaw-Town
JT
Tai
John Jen
JJ
Chen
Gran-Hum
GH
Yeh
Hong-Zen
HZ
Yang
Sheng-Shun
SS
Wang
Hsiu-Po
HP
Kuo
Sung-Hsin
SH
Sheu
Bor-Shyang
BS
Jan
Chang-Ming
CM
Wang
Wen-Ming
WM
Wang
Tsang-En
TE
Wu
Chew-Wun
CW
Chen
Chi-Long
CL
Su
Ih-Jen
IJ
Whang-Peng
Jacqueline
J
Cheng
Ann-Lii
AL
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009853:Omeprazole / Q000008:administration & dosage; D009942:Organometallic Compounds / Q000008:administration & dosage; D011446:Prospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology*; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D008795:Metronidazole; D000658:Amoxicillin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole