Annals of Oncology Advance Access originally published online on February 4, 2009
Annals of Oncology 2009 20(6):1086-1093; doi:10.1093/annonc/mdn760
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hematologic malignancies |
Long-term outcome following Helicobacter pylori eradication in a retrospective study of 105 patients with localized gastric marginal zone B-cell lymphoma of MALT type
1 Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
2 UO Oncologia Medica
3 Anatomia Patologica Università dell'Insubria, Ospedale di Circolo, Varese, Italy
4 Cantonal Institute of Pathology, Locarno, Switzerland
* Correspondence to: Dr E. Zucca, MD, Lymphoma Research Unit, IOSI Oncology Institute of Southern Switzerland, Ospedale San Giovanni, CH-6500 Bellinzona, Switzerland. Tel: +41 91 811 90 40; Fax: +41 91 811 91 82; E-mail: ielsg{at}ticino.com
Background: Treatment aimed at eradicating Helicobacter pylori infection results in lymphoma remission in most localized gastric mucosa-associated lymphoid tissue (MALT) lymphomas. The aim of this survey is to investigate the long-term effect of this therapeutic approach in a large series of patients.
Methods: One hundred and five patients with localized gastric MALT lymphoma were initially treated only with H. pylori eradication regimens. Lymphoma responses were graded using the Wotherspoon score.
Results: Helicobacter pylori, detected by histology in 81% of cases, was eradicated in all positive patients. Histological regression of the lymphoma was achieved in 78 of 102 assessable patients [76%, 95% confidence interval (CI): 67% to 84%] with complete remission (score 0–2) in 66 and partial remission (score 3) in 12. At a median follow-up time of 6.3 years, histological remission was consistently confirmed in 33 of 74 assessable patients, while 25 had score fluctuations (from 0 to 4) and 13 presented a lymphoma relapse (score 5). Only one patient had a distant progression. Transformation to a large-cell lymphoma was seen in two cases. The 5- and 10-year overall survival is 92% (95% CI: 84% to 96%) and 83% (95% CI: 70% to 91%), respectively. Only one patient died of lymphoma after transformation to a high-grade lymphoma.
Conclusions: Helicobacter pylori eradication resulted in complete lymphoma remission in the majority of cases. Long-term clinical disease control was achieved in most patients. A watch and wait policy appears to be safe in patients with minimal residual disease or histological-only local relapse.
Key words: gastric MALT lymphoma, H. pylori eradication, long-term outcome, watch and wait policy
These authors are considered senior authors and contributed equally to the project. Received for publication August 11, 2008. Revision received October 28, 2008. Accepted for publication November 20, 2008.
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