Antibiotic Treatment of Gastric Lymphoma of Mucosa-Associated Lymphoid Tissue. An Uncontrolled Trial

Ann Intern Med. 1999 Jul 20;131(2):88-95. doi: 10.7326/0003-4819-131-2-199907200-00003.

Abstract

Background: Gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is related to Helicobacter pylori infection and may depend on this infection for growth.

Objective: To determine the response of gastric MALT lymphoma to antibiotic treatment.

Design: Prospective, uncontrolled treatment trial.

Setting: University hospital referral center and three collaborating university and community hospitals.

Patients: 34 patients with stage I or stage II N1 gastric MALT lymphoma.

Intervention: Two of three oral antibiotic regimens--1) amoxicillin, 750 mg three times daily, and clarithromycin, 500 mg three times daily; 2)tetracycline, 500 mg four times daily, and clarithromycin, 500 mg three times daily; or 3) tetracycline, 500 mg four times daily, and metronidazole, 500 mg three times daily--were administered sequentially (usually in the order written) for 21 days at baseline and at 8 weeks, along with a proton-pump inhibitor (lansoprazole or omeprazole) and bismuth subsalicylate.

Measurements: Complete remission was defined as the absence of histopathologic evidence of lymphoma on endoscopic biopsy. Partial remission was defined as a reduction in endoscopic tumor stage or 50% reduction in the size of large tumors.

Results: 34 patients were followed for a mean (+/-SD) of 41 +/- 16 months (range, 18 to 70 months) after antibiotic treatment. Of 28 H. pylori-positive patients, 14 (50% [95% CI, 31% to 69%]) achieved complete remission, 8 (29%) achieved partial remission (treatment eventually failed in 4 of the 8), and 10 (36% [CI, 19% to 56%]) did not respond to treatment. Treatment failed in all 6 (100% [CI, 54% to 100%]) H. pylori-negative patients. Patients with endoscopic appearance of gastritis (stage I T1 disease) were most likely to achieve complete remission within 18 months. Tumors in the distal stomach were associated with more favorable response than tumors in the proximal stomach.

Conclusions: A subset of H. pylori-positive gastric MALT lymphomas, including infiltrative tumors, may respond to antibiotics. The likelihood of early complete remission seems to be greatest for superficial and distal tumors.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Bacterial Agents*
  • Anti-Ulcer Agents / therapeutic use
  • Bismuth / therapeutic use
  • Drug Therapy, Combination / therapeutic use*
  • Gastroscopy
  • Helicobacter Infections / complications*
  • Helicobacter pylori*
  • Humans
  • Lymphoma, B-Cell, Marginal Zone / drug therapy*
  • Lymphoma, B-Cell, Marginal Zone / microbiology*
  • Lymphoma, B-Cell, Marginal Zone / pathology
  • Neoplasm Staging
  • Omeprazole / therapeutic use
  • Organometallic Compounds / therapeutic use
  • Prospective Studies
  • Remission Induction
  • Salicylates / therapeutic use
  • Stomach Neoplasms / drug therapy*
  • Stomach Neoplasms / microbiology*
  • Stomach Neoplasms / pathology

Substances

  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Organometallic Compounds
  • Salicylates
  • bismuth subsalicylate
  • Omeprazole
  • Bismuth