title: Long-term follow-up of gastric MALT lymphoma after Helicobacter pylori eradication.
abstract: OBJECTIVE
  Cure of infection induces remissions in most patients with early stage Helicobacter pylori- (Hp) positive gastric MALT (mucosa-associated lymphoid tissue) lymphoma (GML). We tracked the long-term stability of remissions in this prospective, multicenter trial.
  
  
  METHODS
  In 120 patients with stage I(1E) disease, we performed sequential endoscopic-bioptic follow-up after Hp eradication and polymerase chain reaction of the rearranged immunoglobulin heavy chain gene. The status of t(11;18) was assessed in 65 patients.
  
  
  RESULTS
  Median follow-up was 75 months (range, one to 116). Five-year survival was 90%. Eighty percent of patients (96 of 120) achieved complete histologic remission (CR). Eighty percent of CRs are in continuous complete histologic remission (CCR). Three percent of CR patients (three of 96) relapsed and were referred for alternative treatment. Seventeen percent of CR patients (16 of 96) showed histologic residual disease (RD) during follow-up; a watch-and-wait strategy was applied, and all entered into a second CR. After a median follow-up of 63 months, 14 of 52 analyzed patients reaching CR showed ongoing B-cell monoclonality. Fifteen percent of GMLs were t(11;18) positive. Both t(11;18) and ongoing monoclonality were associated with a significantly higher risk for no response or relapse (P =.004, P =.007), but also present in patients in CCR. Early gastric cancer was diagnosed in three cases during follow-up.
  
  
  CONCLUSIONS
  Cure of Hp infection results in CCR in most patients. Histologic RD, B-cell monoclonality, and t(11;18) were present in a considerable number of CR patients. A watch-and-wait strategy is justified when close follow-up is guaranteed.
authors.affiliation: Klinik für Hämatologie, Onkologie und Immunologie, Klinikum der Philipps Universität, Marburg, Germany. wuendisc@med.uni-marburg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Wündisch
authors.forename: Christian
authors.initials: C
authors.lastname: Thiede
authors.forename: Andrea
authors.initials: A
authors.lastname: Morgner
authors.forename: Astrid
authors.initials: A
authors.lastname: Dempfle
authors.forename: Annette
authors.initials: A
authors.lastname: Günther
authors.forename: Hongxiang
authors.initials: H
authors.lastname: Liu
authors.forename: Hongtao
authors.initials: H
authors.lastname: Ye
authors.forename: Ming-Qing
authors.initials: MQ
authors.lastname: Du
authors.forename: Theo D
authors.initials: TD
authors.lastname: Kim
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Bayerdörffer
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Andreas
authors.initials: A
authors.lastname: Neubauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002880:Chromosomes, Human, Pair 11 / Q000235:genetics; D002887:Chromosomes, Human, Pair 18 / Q000235:genetics; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015321:Gene Rearrangement; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D018442:Lymphoma, B-Cell, Marginal Zone / Q000235:genetics / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D013274:Stomach Neoplasms / Q000235:genetics / Q000382:microbiology* / Q000473:pathology; D015996:Survival Rate; D013997:Time Factors; D014178:Translocation, Genetic
chemical_list: D000900:Anti-Bacterial Agents; D007143:Immunoglobulin Heavy Chains