Management and long-term follow-up of early stage H. pylori-associated gastric MALT-lymphoma in clinical practice: an Italian, multicentre study

Dig Liver Dis. 2009 Jul;41(7):467-73. doi: 10.1016/j.dld.2008.09.009. Epub 2008 Oct 21.

Abstract

Background/aim: Data on management and long-term follow-up of Helicobacter pylori-associated MALT-lymphoma in clinical practice are scanty. We evaluate the long-term efficacy of H. pylori eradication on low-grade MALT-lymphoma, and the efficacy of further therapies in refractory patients.

Methods: This study enrolled patients with stages I-II(1) MALT-lymphoma and H. pylori infection. H. pylori eradication was attempted in all patients. Patients with lymphoma persistence or progression following H. pylori treatments received further lymphoma treatments. Both 5-year and disease-free survivals were calculated.

Results: Sixty patients (stage I/II(1): 50/10) were followed up for a median time of 65 months (range 7-156). H. pylori infection was successfully eradicated in 53 (88.3%) patients following three consecutive therapeutic attempts, and lymphoma regressed in 42 (79.2%) of these patients. Sixteen patients received anti-neoplastic treatments due to either lymphoma persistence or progression, and lymphoma was cured in 14 (87.5%) cases. At follow-up, lymphoma relapsed in 13/42 (30.9%) patients within a median time of 19 months (range 3-41), and all but 1 patient were cured with further therapies. Overall, lymphoma regression was achieved in 56 patients (93.3%). The 5-year and disease-free survivals were 94.7% and 74.6%, respectively.

Conclusions: In clinical practice, a conservative approach with antibiotic eradication seems to be appropriate management for early-stage MALT-lymphoma, with oncologic therapy being reserved for those patients who fail to respond to H. pylori therapy.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols
  • Cyclophosphamide
  • Disease-Free Survival
  • Doxorubicin
  • Female
  • Follow-Up Studies
  • Helicobacter Infections / complications
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori* / isolation & purification
  • Humans
  • Italy
  • Kaplan-Meier Estimate
  • Lymphoma, B-Cell, Marginal Zone / drug therapy
  • Lymphoma, B-Cell, Marginal Zone / microbiology*
  • Lymphoma, B-Cell, Marginal Zone / pathology
  • Male
  • Middle Aged
  • Prednisone
  • Proton Pump Inhibitors / therapeutic use
  • Retrospective Studies
  • Stomach Neoplasms / drug therapy
  • Stomach Neoplasms / microbiology*
  • Stomach Neoplasms / pathology
  • Vincristine
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Proton Pump Inhibitors
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CHOP protocol