Gastric MALT lymphoma and its relationship to Helicobacter pylori infection: Management and pathogenesis of the disease

Chronic Helicobacter pylori infection is strongly associated with the devel opment of primary gastric B cell lymphoma of MALT-type. Therapeutic decisio ns in primary gastric MALT lymphomas, e.g., the choice for gastric surgery or stomach-conserving treatments in the form of radio-, chemo-, or eradicat ion therapy, should be based on an accurate histopathological diagnosis, gr ading and clinical staging. Primary gastric low-grade MALT-NHLs in an early clinical stage associated w ith H. pylori infection were shown to respond with complete remission in ap proximately 77% of cases upon successful cure of the infection as only trea tment modality. The effect of curing H. pylori infection on the course of a high-grade gastric MALT lymphoma is largely uncertain but preliminary resu lts indicate a possible benefit for patients with high-grade MALT lymphoma upon eradication therapy. Concerning the pathogenetic mechanisms of lymphomagenesis, there are many q uestions to be adressed in the near future. In general, it is still unclear what the exact mechanisms are which lead to the malignant transformation o f a reactive infiltrate. Is there a molecular-genetic or immunological poin t of no return? What is the biological significance of the immunoglobolin r earrangement detected with PCR? The wave of new data each year about the ro le of H. pylori in gastric MALT lymphoma might help that many of these ques tions adressed above might be answered within the next years. (C) 2000 Wile y-Liss, Inc.