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Helicobacter pylori Eradication Therapy May be Highly Effective Treatment for Gastric Marginal Zone B cell Lymphoma of Mucosa Associated Lymphoid Tissue

Eradication therapy for Helicobacter pylori infection leads to a high rate of complete remission in patients with gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue, according to new research.

Multiple lines of evidence suggest that the pathogenesis of gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT) is critically influenced by ,Helicobacter pylori infection. Due to this evidence, eradication therapy of H pylori has become a well-accepted initial treatment for cases of localised (stage I) low-grade gastric MALT lymphoma.

"Data on the long term outcome of patients undergoing exclusive eradication therapy are rare, and the curative potential of this strategy is still under debate," notes Professor Wolfgang Fischbach, of Klinikum Aschaffenburg, Germany.

To address this uncertainty, Professor Fischbach and colleagues reported a large, multicentre prospective series of 90 patients (mean age, 54.3 years; 57 males) treated exclusively with eradication therapy for gastric marginal zone B cell lymphoma of the MALT.

All patients were given a complete staging work-up and diagnosed with stage I disease and H pylori infection. Eradication therapy was given for one week, and consisted of either OMC (omeprazole 2x20 mg/day, metronidazole 2x400 mg/day, and clarithromycin 2x250 mg/day) or OAC (omeprazole 2x20 mg/day, amoxycillin 2x1000 mg/day, and clarithromycin 2x500 mg/day). Median follow up for the series was 44.6 months (range 12-89).

H pylori eradication was successful in 98% of patients, and complete regression of lymphoma was observed in the long-term outcome of 62% of patients. Among the others, 18% had an outcome characterised by minimal residual disease, and partial remission was achieved in 12% of patients. Progressive disease was reported for only 2% of patients.

Four patients with complete remission relapsed after 6, 8, 8 and 15 months, one of whom presented with reinfection by H pylori. Additional antibiotic treatment for this patient led to bacterial eradication and complete regression of lymphoma.

Based on the high rate of complete remission observed in the study, the researchers conclude that, "the majority of patients treated exclusively in this way have a favourable long term outcome, offering a real chance of cure."

Gut 2004 Jan;53:1:34-7. "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"

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