Eradication Therapy Is Effective for <i>Helicobacter pylori</i>-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

Abstract

Mucosa-associated lymphoid tissue (MALT) lymphomas are extra-nodal B-cell lymphomas arising from MALT, and the most commonly affected organ is the stomach. Helicobacter pylori (H. pylori) eradication therapy with proton-pump inhibitors and antibiotics is the first-line therapy for H. pylori-positive gastric MALT lymphomas, but the effectiveness of the therapy for H. pylori-negative gastric MALT lymphomas remains controversial. Hence, we aimed to evaluate the effectiveness of this eradication therapy for H. pylorinegative MALT lymphomas. The H. pylori infection status of 158 gastric MALT lymphoma patients followed in our unit was judged by urea breath test, rapid urease test, histology of the biopsy specimen taken from the stomach during endocopy, and serum antibody against H. pylori. Seventeen patients that were negative for all four tests and did not have gastric mucosal atrophy were treated with antibiotic eradication therapy. The average age at diagnosis was 56.8 years old (range: 36-73 years), and the median follow-up period after H. pylori eradication in all 17 patients was 5.3 years (range: 0.3-12.7 years). Five patients (29.4%) achieved complete remission (CR) by eradication therapy alone. Comparison between the responding and non-responding patients revealed that the patients endoscopically diagnosed to have a single lesion of gastric MALT lymphoma were seen only in the responding group, whereas all non-responding patients had multiple lesions (P < 0.05). In conclusion, H. pylori eradication therapy achieved a favorable CR rate in H. pylori-negative gastric MALT lymphoma patients and could be considered as a first-line therapy, especially for patients with a single lesion.

Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphomas: A review

“…This was the highest reported response rate among H. pylori-negative gastric MALT lymphomas. The response rate decreased to 46% in their later study [52] , but this was still relatively high compared with other reports [3,[46][47][48][49][50] . Contrary to these reports, earlier studies reported that H. pylorinegative gastric MALT lymphomas did not respond to antibiotic therapy [14,30,45] .…”

“…Nonetheless, further studies are warranted to clarify the cause underlying this discrepancy. Regarding the predictive factor for responsiveness, multiple lesions [49] , lesions in both proximal and distal parts of the stomach [50] , and the presence of t(11;18)(q21;q21) [50] were predictive factors for nonresponsiveness to antibiotic therapy. We have previously reported that 5 out of 17 H. pylori-negative gastric MALT lymphoma patients treated with antibiotics and PPI responded to the therapy, and 3 out of 5 responders had single lesions, while all non-responders had multiple lesions [49] .…”

“…Regarding the predictive factor for responsiveness, multiple lesions [49] , lesions in both proximal and distal parts of the stomach [50] , and the presence of t(11;18)(q21;q21) [50] were predictive factors for nonresponsiveness to antibiotic therapy. We have previously reported that 5 out of 17 H. pylori-negative gastric MALT lymphoma patients treated with antibiotics and PPI responded to the therapy, and 3 out of 5 responders had single lesions, while all non-responders had multiple lesions [49] . Similarly, Choi et al [50] reported that non-responders had lesions in both proximal and distal parts of the stomach, although they did not distinguish patients' H. pylori infection status (2 out of 40 in responders, 4 out of 15 in non-responders).…”

“…The first-line treatment for H. pylori-negative gastric MALT lymphomas is also antibiotic therapy [36] . Even in the absence of H. pylori infection, several studies have reported that certain proportions of patients responded to this antibiotic therapy [3,4,14,30,[45][46][47][48][49][50][51][52] (Table 2). …”

Laparoscopic Sleeve Gastrectomy - An Unexpected Finding: MALT Lymphoma in a H.Pylori-Negative Patient

“…Interestingly, several studies have also demonstrated success in H. pylori therapy for some H. pylori negative MALT lymphoma patients [17,18] implicating other aetiologies in the development of MALT lymphoma.…”