PREDICTIVE VALUE OF ENDOSCOPY AND ENDOSCOPIC ULTRASONOGRAPHY FOR REGRESSION OF GASTRIC DIFFUSE LARGE B‐CELL LYMPHOMAS AFTER HELICOBACTER PYLORI ERADICATION

Abstract

Background: Some gastric diffuse large B-cell lymphomas have been reported to regress completely after the successful eradication of Helicobacter pylori. The aim of this study was to investigate the clinical characteristics of gastric diffuse large B-cell lymphomas without any detectable mucosa-associated lymphoid tissue (MALT) lymphoma that went into complete remission after successful H. pylori eradication. Patients and Methods:We examined the effect of H. pylori eradication in 15 H. pylori-positive gastric diffuse large B-cell lymphoma patients without any evidence of an associated MALT lymphoma (clinical stage I by the Lugano classification) by endoscopic examination including biopsies, endoscopic ultrasonography, computed tomography, and bone marrow aspiration. Results: H. pylori eradication was successful in all the patients and complete remission was achieved in four patients whose clinical stage was I. By endoscopic examination, these gastric lesions appeared to be superficial. The depth by endoscopic ultrasonography was restricted to the mucosa in two patients and to the shallow portion of the submucosa in the other two patients. All four patients remained in complete remission for 7-100 months. Conclusion: In gastric diffuse large B-cell lymphomas without a concomitant MALT lymphoma but associated with H. pylori infection, only superficial cases and lesions limited to the shallow portion of the submucosa regressed completely after successful H. pylori eradication. The endoscopic appearance and the rating of the depth of invasion by endosonography are both valuable for predicting the efficacy of H. pylori eradication in treating gastric diffuse large B-cell lymphomas.

Gastric Diffuse Large B-cell Lymphoma Cured with <i>Helicobacter pylori</i> Eradication Regardless of Whether it Contains Features of MALT Lymphoma

“…The efficacy of HP eradication for gastric pure DLBCL has remained unknown until recently, with the exception of several anecdotal case reports. In 2009, Tari et al reported that HP eradication achieved CR in four of 15 gastric pure DLBCL patients (14). Subsequently, promising results of HP eradication for gastric pure DLBCL were reported by two independent groups in 2012.…”

“…After that review, three papers describing HP eradication for gastric high-grade B-cell lymphoma were published (8,9,14). In total, HP eradication has achieved CR in 65 of 108 (60.2%) cases involving either DLBCL (MALT) or gastric pure DLBCL.…”

“…Nevertheless, HP eradication with antibiotics and proton pump inhibitor is far less toxic and cheaper than chemotherapy. It has been demonstrated that the depth of invasion is an important predictor of the response to HP eradication in both patients with DLBCL (MALT) (7) and pure DLBCL (14). The CR rate achieved with HP eradication ranges from 50% to 100% for gastric lymphomas remaining within the mucosal or submucosal layer (4,8,14), and the median time to CR after eradication is two to five months (4,8).…”

“…It has been demonstrated that the depth of invasion is an important predictor of the response to HP eradication in both patients with DLBCL (MALT) (7) and pure DLBCL (14). The CR rate achieved with HP eradication ranges from 50% to 100% for gastric lymphomas remaining within the mucosal or submucosal layer (4,8,14), and the median time to CR after eradication is two to five months (4,8). Even if HP eradication fails to cure gastric lymphoma, salvage treatment, such as rituximab monotherapy or R-CHOP, brings about CR in most cases (4,8,14).…”

Role of the Endoscopic Ultrasonography in the Management of Gastric Lymphomas: Our Experience and Review of Literature

“…Nevertheless, the most important factor in risk assessment remains the loco regional staging and EUS preserves a great importance due to the fact that it is able to indicate, with accuracy superior to other techniques, the precise loco-regional stage of disease and consequently the required treatment (Pavlović et al 2005). Indeed, PGL of MALT type, when confined to mucosa and sub-mucosa layers responds to HP eradication therapy without any need of chemotherapy, meanwhile DLBCL are usually treated as general disease with chemo-immuno-therapy, even if recent case reports indicated the regression of locally staged DLBCL after HP eradication (Montalban et al, 2001, Tari et al, 2009. Independently from the stage and dissemination, transformation to DLBCL occurs in about 10% of the cases (Zucca et al, 2008 The GIT NHL 02/96 study, confirming the results of the previous study GIT NHL 01/92, revealed that surgery is no longer the better strategy in early-stage low-and high-grade gastric lymphomas (Koch et al, 2005), except when perforation, bleeding or obstruction take place, proving these findings in a cohort of 363 patients.…”