Originally published as JCO Early Release 10.1200/JCO.2005.02.3903 on October 3 2005

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Long-Term Follow-Up of Gastric MALT Lymphoma After Helicobacter Pylori Eradication

From the Klinik für Hämatologie, Onkologie und Immunologie, Klinikum der Philipps Universität, Marburg; Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden; Institut für Medizinische Biometrie und Epidemiologie, Philipps Universität, Marburg; the Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge, England; and the Institut für Pathologie, Klinikum Bayreuth, Bayreuth, Germany

Address reprint requests to Thomas Wündisch, Klinikum der Philipps Universität, Klinik für Hämatologie, Onkologie und Immunologie, 35033 Marburg, Germany; e-mail: wuendisc{at}med.uni-marburg.de

PURPOSE: Cure of infection induces remissions in most patients with early stage Helicobacter pylori- (Hp) positive gastric MALT (mucosa-associated lymphoid tissue) lymphoma (GML). We tracked the long-term stability of remissions in this prospective, multicenter trial.

PATIENTS AND METHODS: In 120 patients with stage I_1E disease, we performed sequential endoscopic-bioptic follow-up after Hp eradication and polymerase chain reaction of the rearranged immunoglobulin heavy chain gene. The status of t(11;18) was assessed in 65 patients.

RESULTS: Median follow-up was 75 months (range, one to 116). Five-year survival was 90%. Eighty percent of patients (96 of 120) achieved complete histologic remission (CR). Eighty percent of CRs are in continuous complete histologic remission (CCR). Three percent of CR patients (three of 96) relapsed and were referred for alternative treatment. Seventeen percent of CR patients (16 of 96) showed histologic residual disease (RD) during follow-up; a watch-and-wait strategy was applied, and all entered into a second CR. After a median follow-up of 63 months, 14 of 52 analyzed patients reaching CR showed ongoing B-cell monoclonality. Fifteen percent of GMLs were t(11;18) positive. Both t(11;18) and ongoing monoclonality were associated with a significantly higher risk for no response or relapse (P =.004, P =.007), but also present in patients in CCR. Early gastric cancer was diagnosed in three cases during follow-up.

CONCLUSION: Cure of Hp infection results in CCR in most patients. Histologic RD, B-cell monoclonality, and t(11;18) were present in a considerable number of CR patients. A watch-and-wait strategy is justified when close follow-up is guaranteed.

Supported by the Deutsche Krebshilfe (grant 70 2251), the Gesellschaft für Gastroenterologie in Bayern, Germany, and the Leukemia Research Fund, UK.

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

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