Clinical Features, Treatment and Outcome in a Series of 93 Patients with Low-Grade Gastric MALT Lymphoma

Abstract

The purpose of this paper is to report the clinical characteristics and treatment outcome following different therapeutic approaches in a large series of patients with primary low-grade MALT lymphoma of the stomach. A total of ninety-three patients (median age 63 years) were reviewed. The patients were treated by different modalities (local treatment alone, combined treatment, chemotherapy, antibiotics alone); seven patients refused any treatment. The antibiotic-treated group of patients was prospectively followed with regular endoscopic biopsies, and their responses were histologically evaluated. The 5-years projected overall survival is 82% (95% C.I.; 67%-91%) in the series as a whole. Second tumors were observed in 21.5% of the patients in this series (95% CI 14%v to 31%). There was no apparent difference in overall survival and event-free survival between patients who received different treatments. In the antibiotic-treated group histologic regression of MALT lymphoma was documented in 67% of patients (95% CI 51% to 80%). In conclusion the indolent nature of the disease justifies a conservative approach. The use of antibiotics as first-line therapy may avert or at least postpone the indication for surgical resection in the majority of patients.

Non-Hodgkin's Lymphoma of Mucosa-Associated Lymphoid Tissue

“…The majority of patients have localized disease at diagnosis. In a European series reporting on 93 patients with low-grade gastric MALT lymphoma, 88% of patients had disease confined to the stomach, either primarily in the antrum (41%) or multifocal (33%) [44]. t(11;18)(q21;q21)-positive lymphomas may present with more advanced features than their t(11;18)(q21;q21)-negative counterparts [17].…”

“…Dyspepsia and epigastric discomfort are the most common presenting symptoms, but gastric bleeding is rare. Systemic B symptoms and bone marrow involvement are present in only 1%-8% of patients [44,45]. Rarely, patients may have elevated lactate dehydrogenase or β 2 -microglobulin levels.…”

Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment

“…11 In the literature, tumour regression after eradication of H pylori with a similar median follow up varied markedly from 41% to 100% (table 2). [4][5][6][7][8][9][10][11] In the present study, complete regression of histological lesions was obtained in 43% of cases and concerned all localised tumours in stages I E and II E1 , whatever their H pylori status.…”

“…10 They argued that non-responders in other series may initially have had more advanced lesions than those reported with possible nodal involvement, and that EUS had not been systematically included in the management of these patients. 9 In the present study, EUS was performed in all cases, and was also much more sensitive than CT scan. The fact that most of the 15 patients with stage II E1 GL underwent gastrectomy prompted us to verify that EUS had good sensitivity in detecting lymph node involvement.…”

Anti‐Helicobacter pylori therapy in localized gastric mucosa‐associated lymphoid tissue lymphoma: A prospective, nationwide, multicenter study in Japan

“…Table 2 indicates 9 retrospective studies 12, 15, 20, 21, 22, 26, 27, 28, 29 of 49‐376 patients. In total, CR was achieved in 852 of 1,055 patients (80.8%) including patients with successful and unsuccessful H. pylori eradication.…”