Long-term follow-up of gastric MALT lymphoma after Helicobacter pylori eradication.
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.
Wündisch
Thomas
T
Klinik für Hämatologie, Onkologie und Immunologie, Klinikum der Philipps Universität, Marburg, Germany. wuendisc@med.uni-marburg.de
Thiede
Christian
C
Morgner
Andrea
A
Dempfle
Astrid
A
Günther
Annette
A
Liu
Hongxiang
H
Ye
Hongtao
H
Du
Ming-Qing
MQ
Kim
Theo D
TD
Bayerdörffer
Ekkehard
E
Stolte
Manfred
M
Neubauer
Andreas
A
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
D000900:Anti-Bacterial Agents; D007143:Immunoglobulin Heavy Chains