Early-stage gastric MALT lymphoma: is it a truly localized disease?
Early-stage gastric mucosa-associated lymphoid tissue lymphoma (GML) is considered a localized disease with an indolent course. Circulating malignant cells have been detected in other early-stage indolent lymphomas by molecular methods. We investigated the incidence of occult blood disease in early-stage GML patients, its impact on clinical outcome, and the similarity between blood and gastric lymphocytic clones. Sixty-two patients with localized GML were included in the study; 51 of them had Helicobacter pylori infection. Monoclonality was investigated by leader polymerase chain reaction. Sequencing was performed for the immunoglobulin variable gene (VH) analysis. Blood involvement was absent in all patients by conventional staging methods. In the whole group of 62 patients, the incidence of blood IgH rearrangement was 45%, and this did not correlate with baseline patient characteristics. The monoclonal blood and gastric products of five patients were sequenced and compared with each other. Clonal identity was evident in four of five patients. The VH3 gene was the most frequently used, both in the blood and in the stomach. Early-stage GML is not a truly localized disease because half the patients had a circulating clone, probably identical to the gastric one. The clinical significance of occult blood disease and the potential appropriate intervention need to be further investigated.
Siakantaris
Marina P
MP
Department of Haematology, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece. msiaka@med.uoa.gr
Pangalis
Gerassimos A
GA
Dimitriadou
Evangelia
E
Kontopidou
Flora N
FN
Vassilakopoulos
Theodoros P
TP
Kalpadakis
Christina
C
Sachanas
Sotirios
S
Yiakoumis
Xanthi
X
Korkolopoulou
Penelope
P
Kyrtsonis
Marie-Christine
MC
Bobotsis
Panayia
P
Androulaki
Athina
A
Patsouris
Eustratios
E
Panayiotidis
Panayiotis
P
Angelopoulou
Maria K
MK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001402:B-Lymphocytes / Q000473:pathology; D005260:Female; D016481:Helicobacter Infections / Q000097:blood / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000097:blood / Q000235:genetics; D007135:Immunoglobulin Variable Region / Q000235:genetics; D016130:Immunophenotyping; D018442:Lymphoma, B-Cell, Marginal Zone / Q000097:blood / Q000235:genetics / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013274:Stomach Neoplasms / Q000097:blood / Q000235:genetics / Q000473:pathology* / Q000821:virology; D016896:Treatment Outcome
D007143:Immunoglobulin Heavy Chains; D007135:Immunoglobulin Variable Region