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Ongoing Monoclonal B-Cell Proliferation Is Not Common in Gastric B-Cell Lymphoma After Combined Radiochemotherapy

From the Departments of Internal Medicine, Hematology, Oncology, and Immunology, Hospital of the Philipps-University, Marburg; Department of Hematology, St Georg Hospital, Hamburg; Institute for Hematopathology, University of Kiel, Kiel; Institute for Pathology, University of Würzburg, Würzburg; and Institute for Pathology, Hospital Bayreuth, Bayreuth, Germany

Address reprint requests to Andreas Neubauer, MD, Hospital of Philipps University, Department of Hematology, Oncology and Immunology, Baldinger Straße, 35033 Marburg, Germany; e-mail: neubauer{at}mailer.uni-marburg.de

PURPOSE: Gastric marginal-zone B-cell lymphoma (MZBCL) of the mucosa-associated lymphoid tissue (MALT) is associated with chronic Helicobacter pylori gastritis. Stable complete remission (CR) can be induced by H pylori eradication. Whether this is paralleled by cure of the lymphoma remains unclear. Persisting monoclonal bands for immunoglobulin heavy chain variable region (V_H) representing the lymphoma clone have been described in up to 50% of patients in CR. This retrospective study investigated whether this phenomenon also occurs after radiochemotherapy.

PATIENTS AND METHODS: Biopsy samples of 20 patients receiving chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone and irradiation were analyzed before and after therapy. Study patients had Ann Arbor stage I/II primary gastric cancer, including four cases of MZBCL of MALT type, 12 cases of diffuse large-cell lymphomas (DLCL), and four cases of mixed MALT type/DLCL. Polymerase chain reaction (PCR) for V_H rearrangement was performed. Monoclonal PCR products were cloned and sequenced.

RESULTS: Fourteen of 20 patients had a monoclonal or oligoclonal band distribution at diagnosis converted into polyclonal pattern after radiochemotherapy. Of the remaining six patients, two were lost to follow-up. One patient did not respond and died of progressive disease. PCR in this patient showed persistent B-cell clonality. In three patients, the initial PCR showed a polyclonal pattern and thus could not be evaluated during follow-up.

CONCLUSION: In contrast with H pylori eradication alone, radiochemotherapy results in clearing of monoclonal cells during follow-up. This may result in better elimination of residual lymphoma cells. Further study is needed to determine whether this translates into lower risk of relapse.

Supported by the Deutsche Krebshilfe (grant No. 70-2251, Ne1).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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