Low Grade Gastric Mucosa-associated Lymphoid Tissue Lymphoma: Clinicopathological Factors Associated with Helicobacter pylori Eradication and Tumor Regression

Abstract

Background/aims: Eradication of Helicobacter pylori is widely accepted as initial therapy for low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. However, approximately 20% of patients with this disease are not responsive to H. pylori eradication therapy. The aim of this study was to assess remission and relapse rates of low-grade gastric MALT lymphoma after H. pylori eradication and identify the clinical factors that affect remission.

Methods: Thirty-nine patients diagnosed with gastric MALT lymphoma (May 2003 to May 2010) were retrospectively analyzed.

Results: Of the 39 patients, 30 (77%) had a H. pylori infection. There were 35/39 (90%) patients with stage I. Among stage I, 25 patients with the infection underwent eradication therapy and 22/25 (88%) achieved remission. The total regression rate with eradication only in stage I was 24/28 (86%). The median time to remission was 98 days (range, 22 to 397 days). Age, tumor location, invasion depth, H. pylori burden, and severity of mononuclear leukocyte and neutrophil infiltration were not related to remission. However, patients with less neutrophil infiltration were more likely to achieve a successful first H. pylori eradication (p=0.049).

Conclusions: The results show that the rate of low-grade gastric MALT lymphoma regression (86%) with H. pylori eradication alone was higher than that in Western studies (77.8%) and that neutrophil infiltration was inversely related to success of the first H. pylori eradication procedure.

Keywords: Eradication; Helicobacter pylori; Lymphoma; Mucosa-associated lymphoid tissue; Remission.

Fig. 1

Therapeutic scheme of 39 mucosa-associated lymphoid tissue (MALT) lymphoma cases at a uni-center study of Seoul National University Bundang Hospital cases from May 2003 to May 2010. Among 39 patients, 26 patients took eradication therapies. CR, complete remission; PR, partial remission; CT, chemotherapy; RT, radiotherapy; FU, follow-up. ^a)Include 2nd-line eradication therapy.

Fig. 2

Trend between the neutrophil infiltration and the eradication. The less neutrophil infiltration tends to have the higher chance of success in the first eradication. G1, group which achieved first eradication success; G2, group which obtained eradication after the second eradication.

Fig. 3

Occurrence of complete remission (CR) event. Kaplan-Meier distribution shows the half of remission occurred within 111 days.