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Annals of Oncology Advance Access originally published online on June 9, 2005
Annals of Oncology 2005 16(9):1539-1544; doi:10.1093/annonc/mdi277
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© 2005 European Society for Medical Oncology

Long-term persistence of molecular disease after histological remission in low-grade gastric MALT lymphoma treated with H. pylori eradication. Lack of association with translocation t(11;18): a 10-year updated follow-up of a prospective study

C. Montalban1,*, A. Santón2, C. Redondo2, M. García-Cosio2, D. Boixeda3, E. Vazquez-Sequeiros3, F. Norman1, C. M. de Argila3, I. Alvarez2, V. Abraira4 and C. Bellas5

Departments of 1 Internal Medicine 2 Pathology 3 Gastroenterology and 4 Biostatistics Unit, Hospital Ramón y Cajal, 5 Department of Pathology, Clínica Puerta de Hierro, Madrid, Spain

* Correspondence to: Dr C. Montalban, Department of Internal Medicine, Hospital Ramón y Cajal, Carretera de Colmenar Km 9, Madrid 28034, Spain. Tel: +34-91-3368279; Fax: +34-91-3369016; Email: cmontalban.hrc{at}salud.madrid.org

Background: Localized low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma can regress after Helicobacter pylori eradication, but IgVH gene monoclonality may persist. We studied the long-term histological and molecular follow-up of 24 patients and the possible association of t(11;18) with the persistent monoclonality.

Patients and methods: From January 1994, 24 untreated patients with stage I low-grade gastric MALT lymphoma associated with H. pylori were prospectively studied. They all received eradication treatment and were sequentially followed-up with endoscopies for histological and molecular studies. Rearrangement of the IgVH gene was studied by PCR analysis. MALT1 locus alterations were studied by FISH.

Results: Twenty-two of the 24 patients (91%) achieved disappearance of the lymphoma. Eighteen (82%) of the 22 histologically cured patients and 16 of the 19 (84%) with long follow-up had monoclonality. Three patterns of development of IgVH gene rearrangements were observed: four patients (21%) had polyclonal rearrangements; eight (58%) had maintained/intermittent monoclonality and four (21%) had occasional monoclonality, mostly after H. pylori reinfection. Only one patient (6%) with persistent monoclonality relapsed. The remaining 18 patients maintained the remission, despite the persistent monoclonality in 15, for a median of 66 months (range 20–113). t(11;18) was not found in any of the patients with persistent monoclonality. Time and the number of endoscopies performed were not related with the occurrence of monoclonality.

Conclusions: In stage I low-grade gastric MALT lymphoma eradication of H. pylori achieves prolonged histological remission in 90% of patients, but molecular remission is not accomplished in most cases. Molecular disease persists for years, but is not associated with t(11;18).

Key words: lymphoma, MALT, MALT lymphoma, gastric lymphoma, H. pylori, t(11;18)


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