Predictive value of endoscopic ultrasonography for regression of gastric low grade and high grade MALT lymphomas after eradication of Helicobacter pylori

Abstract

Background-While a close association between gastric mucosa associated lymphoid tissue (MALT) lymphoma andHelicobacter pylori infection has been established, there are still cases which do not respond to H pylori eradication. Aims-To investigate the clinicopathological factors which may help predict the therapeutic eYcacy of H pylori eradication in gastric MALT lymphoma. Patients-Forty one patients with gastric MALT lymphoma, including low and high grade lesions. Methods-After endosonographic staging was determined, H pylori was eradicated in all patients, and the subsequent gastric pathological course was then investigated. Results-Complete regression of MALT lymphoma was observed in 29(71%) patients, partial regression in five (12%), and no regression in seven (17%). Twenty six (93%) of 28 MALT lymphomas restricted to the mucosa but only three (23%) of 13 lymphomas which invaded the deep portion of the submucosa or beyond completely regressed. Kaplan-Meier analysis for the probability of complete regression of MALT lymphoma revealed a significant diVerence between tumours restricted to the mucosa and those invading the submucosa deeply or beyond (p<0.05). Neither the presence of a high grade component, perigastric lymphadenopathy, nor clinical staging prior to eradication correlated with the probability of lymphoma regression. Conclusions-Assessment of deep submucosal invasion by endosonography is valuable for predicting the eYcacy of H pylori eradication in gastric MALT lymphoma. (Gut 2001;48:454-460)

Primary gastrointestinal lymphoma in Japan

“…Among the 153 patients treated by chemotherapy, 142 received four or six cycles of the cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen and the remaining 11 patients were treated by oral monochemotherapy with cyclophosphamide. 34 Of the 445 treated patients, 378 patients (83%) achieved a CR, 50 (11%) achieved a partial remission, and 17 (4%) showed no response. Table 2 indicates the clinicopathologic features of the three groups classified by primary site of lymphoma.…”

“…All cases satisfied the criteria for primary gastrointestinal lymphoma as defined by Lewin et al 6 The subjects in our previous studies [32][33][34] were included in the current study. Pediatric patients younger than 15 years of age were excluded from this study.…”

“…The depth of tumor invasion was determined by endoscopic ultrasonography in 150 patients. 34 Otherwise, the depth was determined by histology of the resected specimens.…”

“…However, in recent years, patients with gastrointestinal lymphomas have received nonsurgical treatments at our institution (Kyushu University, Fukuoka, Japan). 34 In addition, the prognostic data on patients with lymphoma of multiple involvements remain to be elucidated. To determine the prognostic factors for gastrointestinal lymphoma and to evaluate the influence of therapeutic modalities on the prognosis, we analyzed a large number of patients with special reference to the MALT concept and time trends.…”

Extranodal and splenic small B-cell lymphoma

“…These include deep penetration of the gastric wall, a t(11;18)(q21;q21) strong nuclear staining for BCL10 and lack of underlying H. pylori infection. [29][30][31][32] Depth of invasion of the wall and the presence of the translocation may not be independent predictors of response as lymphomas with deep mural extension at presentation frequently are positive for the translocation. 33 Following eradication therapy, examination of subsequent biopsies for regression of the tumour is essential.…”