title: Helicobacter pylori and gastric mucosa-associated lymphoid tissue lymphoma: recent progress in pathogenesis and management.
abstract: Recent progress in the research regarding the molecular pathogenesis and management of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is reviewed. In approximately 90% of cases, Helicobacter pylori (H. pylori) infection plays the causative role in the pathogenesis, and H. pylori eradication is nowadays the first-line treatment for this disease, which leads to complete disease remission in 50%-90% of cases. In H. pylori-dependent cases, microbe-generated immune responses, including interaction between B and T cells involving CD40 and CD40L co-stimulatory molecules, are considered to induce the development of MALT lymphoma. In H. pylori-independent cases, activation of the nuclear factor-κB pathway by oncogenic products of specific chromosomal translocations such as t(11;18)/API2-MALT1, or inactivation of tumor necrosis factor alpha-induced protein 3 (A20) are considered to contribute to the lymphomagenesis. Recently, a large-scale Japanese multicenter study confirmed that the long-term clinical outcome of gastric MALT lymphoma after H. pylori eradication is excellent. Treatment modalities for patients not responding to H. pylori eradication include a "watch and wait" strategy, radiotherapy, chemotherapy, rituximab immunotherapy, and a combination of these. Because of the indolent behavior of MALT lymphoma, second-line treatment should be tailored in consideration of the clinical stage and extent of the disease in each patient.
authors.affiliation: Shotaro Nakamura, Department of R/D for Surgical Support System, Center for Advanced Medical Innovation, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Shotaro Nakamura, Department of R/D for Surgical Support System, Center for Advanced Medical Innovation, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000276:immunology / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D018579:Patient Selection; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000276:immunology / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gastric lymphoma; Helicobacter pylori; Mucosa-associated lymphoid tissue lymphoma; Nuclear factor κB