title: De-escalating therapy in gastric aggressive lymphoma.
abstract: The treatment of primary gastric diffuse large B-cell lymphoma (DLBCL) has changed radically over the last 10-15 years, with the abandonment of routine gastrectomy in favor of more conservative therapies. Low-level evidence suggests that consolidation radiotherapy could be avoided in patients with limited-stage DLBCL of the stomach who achieve complete remission after rituximab-CHOP combination. Small, recent prospective trials suggest that selected patients with limited-stage Helicobacter pylori (H. pylori)-positive DLBCL of the stomach and favorable prognostic factors can be managed with antibiotics alone, with excellent disease control and cure rates, keeping chemo-radiotherapy for unresponsive patients. This recommendation should equally regard patients with mucosa-associated lymphoid tissue-related or de novo DLBCL. Future studies should be focused on the establishment of reliable variables able to distinguish the best candidates for exclusive treatment with H. pylori eradication from those who need for conventional chemo-immunotherapy.
authors.affiliation: Rosanna Cuccurullo, Silvia Govi, Andrés JM Ferreri, Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Cuccurullo
authors.affiliation: Rosanna Cuccurullo, Silvia Govi, Andrés JM Ferreri, Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Govi
authors.affiliation: Rosanna Cuccurullo, Silvia Govi, Andrés JM Ferreri, Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Andrés J M
authors.initials: AJ
authors.lastname: Ferreri
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D005743:Gastrectomy; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000472:pathogenicity; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology / Q000532:radiotherapy; D018579:Patient Selection; D012074:Remission Induction; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology / Q000532:radiotherapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic therapy; Diffuse large B-cell lymphoma; Gastric lymphoma; Helicobacter pylori; Rituximab
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