Histological and immunological parameters to predict treatment outcome of Helicobacter pylori eradication in low-grade gastric MALT lymphoma

Helicobacter pylori eradication is generally accepted as the first choice o f treatment for stage LE low-grade gastric MALT lymphoma (mucosa-associated lymphoid tissue-type lymphoma). Treatment failure mag be attributed to the extent of the disease and to progression into an antigen-independent phase , This study assessed the value of morphological grading and the expression of the co-stimulatory markers CD40, CD80 and CD86 and their ligands to pre dict clinical outcome in 23 consecutive low-grade MALT lymphoma patients tr eated with H, pylori eradication, Complete regression was achieved in 13/23 patients (56%), partial regression in two (9%), and no response in eight ( 35%). Histological grading was highly predictive of clinical response, espe cially in stage IE, patients, with complete remissions in 10/12 tumours wit h purely low-grade (type A) morphology and 1/8 tumours with increased numbe rs of blasts (type B) (p = 0.0046) and was related to the expression of cos timulatory markers (p = 0.0061), Moreover, CD86 as a single marker proved t o be of predictive value for treatment outcome (p = 0.0086), These results suggest that morphological grading and immunological criteria can be define d to recognize the transition into the antigen-independent phase of gastric MALT-NHL. In addition to clinical stage, these critera may in future serve as a practical pathological guide to the choice of therapy. Copyright (C) 2000 John Wiley & Sons, Ltd.