Clinical, histological and molecular follow-up of 60 patients with gastric marginal zone lymphoma of mucosa-associated lymphoid tissue

Virchows Arch. 2005 Mar;446(3):219-24. doi: 10.1007/s00428-005-1217-3. Epub 2005 Mar 2.

Abstract

The persistence of gastric lymphoma after Helicobacter pylori eradication may be difficult to evidence on endoscopic and histological examination. The aims of the study were to evaluate the detection of monoclonal immunoglobulin H (IgH) gene rearrangement in endoscopically infiltrated and normal mucosa at diagnosis and during follow-up in order to determine its clinical and prognostic impact. We studied 60 gastric marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT), and IgH monoclonality was detected at diagnosis in 52 patients (87%). The endoscopically normal mucosa contained clonal lymphomatous cells in 69% of cases before remission. A complete histological remission (HR) was observed in 28 patients (47%). Among them, 23 were followed for molecular remission (MR). The median delay was 10 months to achieve HR and 18 months to achieve MR. Interestingly, patients with HR but not MR had a longer delay to achieve HR (21 months) (P=0.0006) and a more frequent clonal normal mucosa at diagnosis (88%) than patients with both HR and MR (10 months and 39%, respectively). The presence of monoclonal B cells at both infiltrated and normal sites may therefore identify patients with a longer delay to achieve complete response, suggesting that molecular dissemination may require therapeutic intensification.

Publication types

  • Comparative Study

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Amoxicillin / therapeutic use
  • Anti-Infective Agents / therapeutic use
  • Clarithromycin / therapeutic use
  • Drug Therapy, Combination / therapeutic use
  • Female
  • Follow-Up Studies
  • Gastric Mucosa / immunology
  • Gastric Mucosa / pathology
  • Gene Rearrangement / immunology*
  • Helicobacter Infections / drug therapy
  • Helicobacter pylori / drug effects
  • Humans
  • Immunoglobulin Heavy Chains / genetics*
  • Lansoprazole
  • Lymphoma, B-Cell, Marginal Zone / genetics*
  • Lymphoma, B-Cell, Marginal Zone / immunology*
  • Lymphoma, B-Cell, Marginal Zone / pathology
  • Male
  • Middle Aged
  • Omeprazole / analogs & derivatives*
  • Omeprazole / therapeutic use
  • Polymerase Chain Reaction
  • Prognosis
  • Remission Induction
  • Stomach Neoplasms / genetics*
  • Stomach Neoplasms / immunology*
  • Stomach Neoplasms / pathology

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Infective Agents
  • Immunoglobulin Heavy Chains
  • Lansoprazole
  • Amoxicillin
  • Clarithromycin
  • Omeprazole