Prospective study of Helicobacter pylori eradication therapy in stage I-E high-grade mucosa-associated lymphoid tissue lymphoma of the stomach

Purpose: High-grade mucoso-associated lymphoid tissue (MALT) lymphomas of t he stomach are generally believed to be Helicobacter pylori-independent, au tonomously growing tumors. However, anecdotal cases of regression of high-g rade lymphomas after the cure of H pylori infection had been described. The present prospective study was conducted to evaluate the effect of anti-H p ylori therapy in stage I-E high-grade gastric MALT lymphomas. Patients and Methods: Sixteen patients with H pylori infection and stage I- E gastric high-grade MALT lymphoma consented to a brief antibiotic therapy as first-line treatment from June 1995 through April 2000. Then, patients u nderwent intensive endoscopic follow-up examinations (+/- endoscopic ultras onography) with biopsy to evaluate tumor response. Patients with significan t improvement of gross lesions that accompanied regression of large cells w ere followed up without additional treatment. Patients without significant improvement were immediately referred to systemic chemotherapy. Results: Eradication of H pylori was achieved in 15 patients and was accomp anied by rapid gross tumor regression and disappearance of large cells in 1 0. All 10 of these patients with early response had subsequent complete his tologic remission of lymphoma. The complete remission rate was 62.5% (95% c onfidence interval, 35.8% to 89.1%). The response rate was not affected by the tumor grading (proportion of large blast cells within the tumor) but wa s adversely affected by the depth of tumor invasion. At a median follow-up of 43.5 months (range, 21.1 to 67.4 months), all 10 of these patients remai ned lymphoma-free. The median duration of complete response was 31.2 months (range, 14.4 to 49.1 months). Conclusion: These results suggest that high-grade transformation is not nec essarily associated with the loss of H pylori dependence in early-stage MAL T lymphomas of the stomach. (C) 2001 by American Society of Clinical Oncolo gy.