Long term outcome of patients with gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT) following exclusive Helicobacter pylori eradication therapy: experience from a large prospective series

Fischbach W; Goebeler-Kolve M-E; Dragosics B; Greiner A; Stolte M
January 2004
Gut;Jan2004, Vol. 53 Issue 1, p34
Academic Journal
BACKGROUND: Helicobacter pylori plays a decisive role in the pathogenesis of gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT), and eradication therapy has become a widely accepted initial treatment of stage I disease. OBJECTIVE: To determine the long term outcome of patients undergoing exclusive H pylori eradication therapy. DESIGN: A prospective series of patients with newly diagnosed marginal zone B cell lymphoma of MALT. SETTING: Multicentre study in Germany and Austria. PATIENTS: Ninety five patients; 90 of these (five lost to follow up) with a mean age of 54.3 (27-85) years were followed up for at least 12 months. INTERVENTION: Complete staging work up revealing stage I disease and H pylori infection. Patients received triple therapy (OMC: omeprazole 20 mg twice daily, metronidazole 400 mg twice daily, and clarithromycin 250 mg twice daily; or OAC: omeprazole 20 mg twice daily, amoxycillin 1000 mg twice daily, and clarithromycin 500 twice daily) for one week. RESULTS: Median follow up was 44.6 (12-89) months. H pylori was successfully eradicated in 88 patients (98%); in two patients eradication therapy failed. Long term outcome was characterised by complete regression of lymphoma in 56 patients (62%), minimal residual disease in 17 patients (18%), partial remission in 11 patients (12%), no change in four patients (4%), and progressive disease in two patients (2%). Four patients with complete remission relapsed after 6, 8, 8, and 15 months, one revealing reinfection by H pylori. Regression rate was higher in stage I1 disease compared with stage I2, as diagnosed by endoscopic ultrasound. CONCLUSION: The majority of patients with low grade gastric MALT lymphoma treated by exclusive H pylori eradication have a favourable long term outcome, offering a real chance of cure.


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