Patients with Helicobacter pylori negative gastric marginal zone b-cell lymphoma (MZBCL) of MALT have a good prognosis

Abstract

Background: In current guidelines H. pylori eradication is recommended as first-line therapy in patients with gastric MALT lymphoma irrespective of stage and H. pylori status. However, data on treatment and clinical course of patients with H. pylori negative MALT lymphoma are rare.

Aim: To evaluate therapeutical results in patients with H. pylori negative gastric MALT lymphoma.

Methods: 21 patients (13 male and 8 female; 63.9 years, range 43 – 80) with gastric MALT lymphoma were analysed retrospectively on the basis of medical reports in all cases and repeated outpatient visits at our center in 17 cases. H. pylori infection was excluded by negative histology, rapid urease test, or C13 urease breath test, and serology in all cases. Follow-up was 56.4 (5 – 142) months.

Results: Ten of 21 patients were treated with H. pylori eradication, and four of them received no further therapy. The other six patients underwent surgery, chemotherapy, and radiation, after eradication therapy. Those eleven patients without H. pylori eradication received radiation (n = 3), chemotherapy (n = 1), PPIs (n = 2), no treatment (n = 4) as first-line and radiation (n = 2) as second-line therapy while initial therapy remained unknown in one case. 13 patients (61.9 %) reached complete remission of lymphoma, and seven patients (33.3 %) showed minimal histological residuals. Overall and disease-free survival was found in 95 % and 90 %, respectively.

Conclusion: Patients with H. pylori negative gastric MALT lymphoma have a good prognosis. We favor initial H. pylori eradication therapy and a watch-and-wait strategy in case of minimal histological residuals of MALT lymphoma. Non-responders to eradication therapy can be successfully treated by radiation and chemotherapy.

Zusammenfassung

Hintergrund: In den bestehenden Leitlinien wird die H.-pylori-Eradikation als Erstlinientherapie bei Patienten mit gastralen MALT-Lymphomen unabhängig von Stadium und H.-pylori-Status empfohlen. Es existieren indessen nur spärliche Daten zur Behandlung und zum klinischen Verlauf von Patienten mit H.-pylori-negativen MALT-Lymphomen.

Ziel: Das Therapieansprechen bei Patienten mit H.-pylori-negativen gastralen MALT-Lymphomen.

Methode: 21 Patienten (13 Männer und 8 Frauen; mittleres Alter 63,9 Jahre, Alterspanne 43 – 80) mit gastralen MALT-Lymphomen wurden retrospektiv auf der Basis der Krankenunterlagen in allen Fällen und wiederholter ambulanter Untersuchungen in unserem Zentrum in 17 Fällen analysiert. Eine H.-pylori-Infektion war durch negative Histologie, Urease-Test oder 13C-Harnstoff-Atemtest und Serologie in allen Fällen ausgeschlossen. Der Beobachtungszeitraum betrug 56,4 (5 – 142) Monate.

Ergebnisse: Zehn von 21 Patienten wurden einer H.-pylori-Eradikation zugeführt; vier von ihnen erhielten keine weitere Therapie. Die anderen 6 Patienten wurden nach der Eradikation operiert oder mittels Chemotherapie oder Bestrahlung behandelt. Von den 11 Patienten ohne H.-pylori-Eradikation erhielten in der Erstlinienbehandlung 3 eine Bestrahlung, einer eine Chemotherapie, 2 PPIs und 4 blieben ohne jede Therapie. Zwei Patienten wurden in der Zweitlinie bestrahlt, in einem Fall blieb die initiale Therapie unbekannt. 13 Patienten (61,9 %) erreichten eine komplette Lymphomremission. Sieben Patienten (33,3 %) ließen nur minimale histologische Residuen des MALT-Lymphoms erkennen. Die Gesamtüberlebensrate betrug 95 %, das krankheitsfreie Überleben 90 %.

Schlussfolgerung: Patienten mit H.-pylori-negativen gastralen MALT-Lymphomen haben eine gute Prognose. Wir favorisieren eine initiale H.-pylori-Eradikation und eine zuwartende Haltung im Falle von nur minimalen histologischen Residuen des MALT-Lymphoms. Patienten, die auf die Eradikationsbehandlung nicht ansprechen, können erfolgreich mittels Bestrahlung und Chemotherapie behandelt werden.

Schlüsselwörter

MALT-Lymphom - Helicobacter pylori - Magen

Key words

MALT Lymphoma - Helicobacter pylori - Gastric

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