The Possible Involvement of Micro-Organisms Other Than Helicobacter pylori in the Development of Rectal MALT Lymphoma in H. Pylori-Negative Patients

Nakase, Hiroshi; Okazaki, Kazuichi; Ohana, Masaya; Ikeda, Kazuki; Uchida, Kazushige; Uose, Suguru; Itoh, T.; Iwano, Masahiro; Watanabe, Norihiko; Yazumi, Shujiro; Kawanami, Chiharu; Inoue, Fumihiko; Chiba, Tsutomu

doi:10.1055/s-2002-23643

Cited by 65 publications

(41 citation statements)

References 7 publications

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“…Tumor regression was not affected by the types of antibiotics administered or by the presence or absence of proton pump inhibitors. There were seven reported H. pylori-negative patients, in whom colonic MALT lymphoma regression was attained by the administration of antibiotics; these were the three cases reported by Nakase et al 6 (including one case described by Inoue and Chiba 2 ), the case reported by Oiya and coworkers, 7 and the three cases reported in this study. From these reports, the presence or absence of gastric H. pylori is considered to have had no apparent impact on the effectiveness of antibiotics against colonic MALT lymphomas.…”

Section: Discussionsupporting

confidence: 50%

Deep infiltrative low-grade MALT (mucosal-associated lymphoid tissue) colonic lymphomas that regressed as a result of antibiotic administration: endoscopic ultrasound evaluation

et al. 2005

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Since 1997 we have experienced three cases of low-grade colonic mucosal-associated lymphoid tissue (MALT) lymphomas. The depth of tumor invasion was evaluated by endoscopic ultrasonography (EUS) and the mass lesions were all diagnosed as having extended beyond the deep region of the submucosal layer. Although all of these patients tested negative for gastric Helicobacter pylori, their tumor lesions regressed after antibiotic treatment in accordance with H. pylori eradication therapy. In general, consensus has been reached regarding antibiotic therapy for gastric MALT lymphomas. However, as a prerequisite for antibiotic therapy, the therapy has been deemed effective against these gastric tumors if the extent of infiltration, as evaluated by EUS, is limited to the mucosal layer or the superficial region of the submucosal layer. Based on the therapeutic outcomes seen in the three patients studied here, it is suggested that antibiotic therapy might be useful in treating MALT lymphomas of the colon, even in patients with advanced invasive tumors, in contrast to the extent of the lesions in the stomach suitable for antibiotic treatment. The success of the antibiotic treatment also suggests that MALT lymphomas may be caused by unknown luminal microorganisms, other than H. pylori.

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Section: Discussionsupporting

confidence: 50%

Deep infiltrative low-grade MALT (mucosal-associated lymphoid tissue) colonic lymphomas that regressed as a result of antibiotic administration: endoscopic ultrasound evaluation

et al. 2005

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“…Among several endoscopically observed gross appearances of gastric MALT lymphoma, cobblestone mucosa and a submucosal tumor-like appearance may be clinically relevant for predicting unresponsiveness to antibacterial treatment. In addition, a few cases of MALT lymphoma arising in anatomical sites other than the stomach were documented to show disease regression after being treated with antibiotics, 49,50 suggesting involvement of H. pylori or other microorganisms in its development. This phenomenon should be also comprehensively analyzed to broaden the clinical implication of antibacterial treatment for MALT lymphoma.…”

Section: Resultsmentioning

confidence: 99%

Gastric low-grade B-cell MALT lymphoma: treatment, response, and genetic alteration

Nakamura

Inagaki

Seto

et al. 2003

Journal of Gastroenterology

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Approximately 10% of gastric low-grade B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) type are unresponsive to Helicobacter pylori ( H. pylori) eradication treatment, and many of them contain an API2-MALT1 chimeric transcript mediated by t(11;18)(q21;q21) translocation. We here review the current status on the interrelationship among clinical features, H. pylori infection status, responsiveness to antibacterial treatment, and API2-MALT1 chimeric transcript of gastric MALT lymphoma in a unicenter study experience and discuss the clinicopathologic significance of API2-MALT1 chimeric transcript in gastric MALT lymphoma. We enrolled 59 patients with gastric MALT lymphoma in a unicenter study. H. pylori infection status and clinical stages were investigated. Antibacterial treatment and subsequent follow-up endoscopy were performed for the assessment of responsiveness of MALT lymphoma in every patient. All cases were examined for API2-MALT1 chimeric transcript by means of RT-PCR and sequencing analyses using RNA extracted from tissues. H. pylori infection status was assessed as positive in 50 patients and negative in 9. Antibacterial treatment achieved complete or partial remission in 41 patients and no change in 12. API2-MALT1 chimeric transcript was detected in 9 patients, all of whom showed no change in response to treatment. Notably, responsiveness to H. pylori eradication treatment most clearly delineated the enrolled cases into two groups, indicating that six factors ( H. pylori infection, API2-MALT1 chimeric transcript, cobblestone mucosa and submucosal tumor in gross appearance, nodal involvement, and clinical stage) were statistically significant. On the other hand, comparison of two groups from the standpoint of H. pylori or API2-MALT1 chimeric transcript status revealed a lesser number of the statistically significant factors (two and three, respectively). Gastric MALT lymphoma characterized by unresponsiveness to antibacterial treatment contains all API2-MALT1 chimeric transcript-positive cases and may constitute a distinct group often seen with nodal involvement and an advanced clinical stage. This group is thought to be unrelated to H. pylori infection in its pathogenesis, and might share a unifying feature of genetic alteration such as involving the MALT1 locus on chromosome 18. Investigation in the future will clarify this issue and establish the clinical implication of such genetic alteration as the predictive factor for gastric MALT lymphoma.

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“…We also experienced CR achieved in a patient who did not respond to the standard first-line eradication therapy and therefore received metronidazole (patient 1). In addition, previous studies reported that H. pylori eradication therapy was effective for H. pylori-negative rectal MALT lymphomas (Nakase et al 2002;Nomura et al 2010). These previous reports and our study suggest the possibility that microorganisms other than H. pylori are involved in the development of MALT lymphomas, which could account for the effectiveness of different antibiotics on H. pylori negative MALT lymphomas, but further studies are warranted.…”

Section: Discussionmentioning

confidence: 97%

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

Asano

Iijima

Terai

et al. 2012

Tohoku J. Exp. Med.

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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.

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The Possible Involvement of Micro-Organisms Other Than Helicobacter pylori in the Development of Rectal MALT Lymphoma in H. Pylori-Negative Patients

Cited by 65 publications

References 7 publications

Deep infiltrative low-grade MALT (mucosal-associated lymphoid tissue) colonic lymphomas that regressed as a result of antibiotic administration: endoscopic ultrasound evaluation

Deep infiltrative low-grade MALT (mucosal-associated lymphoid tissue) colonic lymphomas that regressed as a result of antibiotic administration: endoscopic ultrasound evaluation

Gastric low-grade B-cell MALT lymphoma: treatment, response, and genetic alteration

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

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