© 2005 Oxford University Press
ARTICLE |
Long-Term Results of Anti–Helicobacter pylori Therapy in Early-Stage Gastric High-Grade Transformed MALT Lymphoma
Affiliations of authors: Divisions of Cancer Research (L-TC, JW-P), Biostatistics and Bioinformatics (JJT), and Clinical Research (I-JS), National Health Research Institutes, Taipei; Taiwan; Departments of Internal Medicine (J-TL, A-LC), Emergency Medicine (H-PW), and Oncology (S-HK, A-LC), National Taiwan University Hospital, Taipei, Taiwan; Division of Biostatistics, Institute of Epidemiology, National Taiwan University, Taipei, Taiwan (JJT); Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan (G-HC, H-ZY, S-SY); Division of Gastroenterology, Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan (B-SS); Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (L-TC, C-MJ, W-MW); Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan (T-EW); Department of Surgery, Veterans General Hospital, Taipei, Taiwan (C-WW); Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan (C-LC)
Correspondence to: Dr. Li-Tzong Chen, MD, PhD, Division of Cancer Research, National Health Research Institutes, Taipei, Taiwan (e-mail: leochen{at}nhri.org.tw).
Background: Several independent clinical studies have reported that Helicobacter pylori eradication therapy could achieve complete remission in some patients with H. pylori–positive early-stage gastric mucosa–associated lymphoid tissue (MALT) lymphoma. Methods: To compare the long-term results of anti–H. pylori therapy in early-stage, gastric low-grade and high-grade transformed MALT lymphoma, two multicenter prospective studies of anti–H. pylori therapy for early-stage gastric lymphoma conducted in Taiwan, one for low-grade MALT lymphoma, with 34 patients enrolled from March 1996 through April 1999, and one for high-grade transformed tumors (diffuse large B-cell lymphoma with features of MALT, DLBCL[MALT] lymphoma), with 24 patients enrolled since June 1995, were directly compared. In both studies, patients generally received 2 weeks of antibiotics and had multiple sequential follow-up endoscopic examinations until complete histologic remission (CR) or disease progression; patients were monitored through January 31, 2004. CR was defined as regression of lymphoid infiltration to Wotherspoon's score of 2 or less on all pathologic sections of endoscopic biopsy specimens. All statistical tests were two-sided. Results: The H. pylori–positive rate among the 34 low-grade patients was 94% (32 of 34). All 24 selected high-grade patients were H. pylori positive. H. pylori was eradicated in 97% (30 of 31) of evaluable H. pylori–positive low-grade patients and in 92% (22 of 24) of high-grade patients, which led to CR in 80% (24 of 30, 95% confidence interval [CI] = 65% to 95%) and 64% (14 of 22, 95% CI = 42% to 86%) of patients, respectively. None of the five patients who were either initially H. pylori negative or had persistent H. pylori infection after antibiotics achieved CR. After median follow-up of more than 5 years in complete responders, tumor recurrence was observed in three (13%) low-grade patients but not in high-grade patients. Conclusions: Anti–H. pylori therapy may be considered as one of the treatment options for early-stage H. pylori–positive gastric DLBCL(MALT), and large-scale prospective studies to validate its use as first-line therapy for such tumors should be undertaken.
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