Regression of gastric high grade mucosa associated lymphoid tissue (MALT) lymphoma after Helicobacter pylori eradication

Abstract

Background-Most low grade gastric lymphomas arising from the mucosa associated lymphoid tissue (MALT) are related to Helicobacter pylori colonisation. Cases with disease limited to the stomach can be cured after H pylori eradication and remain in remission for years. In contrast, high grade lymphomas of the stomach, although also related to H pylori, do not usually respond to eradication treatment. Case report-A 36 year old patient was referred from another hospital with a diagnosis of a low grade gastric MALT lymphoma associated with H pylori. The patient was in stage I and while waiting for the biopsies to be reviewed H pylori eradication therapy was given as the first step of treatment. Review of the biopsies showed a high grade immunoblastic lymphoma with areas of low grade gastric MALT lymphoma (high grade gastric MALT lymphoma or diVuse large B cell lymphoma with areas of MALT type lymphoma of the WHO classification). The patient received no further treatment but has been closely followed up for 32 months with sequential endoscopies to obtain biopsies for histological studies, H pylori cultures, and polymerase chain reaction analysis of the IgH gene. Results-After H pylori eradication the patient had a complete histological response that has been maintained for 32 months. Monoclonal IgH gene rearrangement persisted for 32 months. Conclusion-The response of this patient indicates the possibility that some cases of high grade gastric MALT lymphoma (possibly patients in stage I with a superficial or limited disease) may still be responsive to H pylori antigenic drive and may be cured with eradication therapy. Prospective studies should be performed to identify patients with high grade gastric MALT lymphomas that may respond to eradication therapy and be spared of other more aggressive treatments. (Gut 2001;49:584-587)

Primary gastric mucosa associated lymphoid tissue lymphoma: Clinical data predicted treatment outcome

“…Rather it suggests that after eradication therapy as the initial treatment in patients with limited superficial disease, no infiltration of deeper layers of the gastric wall, and limited areas of high grade lymphoma, and most of all, when these patients can be closely monitored, chemotherapy may be postponed until follow up indicates whether or not further treatment is necessary. A prospective study of larger numbers of such patients may help to detect the factors that may predict a good response to H pylori eradication to avoid the use of an unnecessary and toxic treatment such as chemotherapy in patients that may already have been cured [24,25] . In our group of patients, we have a large proportion Figure 4 Kaplan-Meir curve of cumulative survival probability in gastric MALT lymphoma patients.…”

Complete remission of gastric Burkitt’s lymphoma aftereradication of Helicobacter pylori

“…Eradication of H pylori is now well established as the first line treatment of gastric MALT lymphoma [8] and reports in the literature show 60%-80% remission rates [9][10][11] . In addition, several cases of complete remission of gastric DLBCL after H pylori eradication have been reported [12][13][14][15][16] . On the contrary, BL is known to require aggressive chemotherapy in order to induce remission, with systemic and intrathecal chemotherapy, and the impact of H pylori eradication on gastric BL has never been evaluated.…”

Novel Probiotic Bifidobacterium bifidum CECT 7366 Strain Active against the Pathogenic Bacterium Helicobacter pylori

“…In fact, in 1994 the International Agency for Research on Cancer declared H. pylori a class I carcinogen (24). The eradication of H. pylori is recognized to be a valuable treatment against the aforementioned diseases (5,37,48,53).…”