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Antibiotic Treatment Is Not Effective in Patients Infected With Helicobacter pylori Suffering From Extragastric MALT Lymphoma

Birgit Grünberger, Stefan Wöhrer, Berthold Streubel, Michael Formanek, Ventzislav Petkov, Andreas Puespoek, Michael Haefner, Michael Hejna, Ulrich Jaeger, Andreas Chott, Markus Raderer

From the Departments of Medicine I and IV, Pathology, and Otorhinolaryngology, Medical University Vienna, Vienna, Austria

Address reprint requests to Markus Raderer, MD, Department of Medicine I, Division of Oncology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; e-mail: markus.raderer{at}meduniwien.ac.at

PURPOSE: Apart from anecdotal reports implicating Helicobacter pylori (HP) in the development of extragastric mucosa associated lymphoid tissue (MALT) lymphoma, no large scale prospective studies have been performed on this topic.

PATIENTS AND METHODS: A total of 77 patients with extragastric MALT lymphoma were prospectively studied. The presence or absence of HP was tested by histology, urease breath test, and serology. Patients were also tested for hepatitis A, B, and C and autoimmune conditions along with assessment of MALT lymphoma-specific genetic changes.

RESULTS: Evidence for infection with HP was present in 35 of 77 patients (45%), and three of 75 patients tested (4%) were positive for hepatitis C and one for hepatitis B. All patients with HP-infection underwent eradication, 16 before initiation of further therapy. Apart from one patient with lymphoma involving parotid and colon, who achieved regression of the colonic lesions, none of these 16 patients showed regression of the lymphoma after a median follow-up of 14 months (range, 8 to 48+ months) before initiation of definitive treatment. No correlation between HP-status, localization, stage, autoimmune diseases, and genetic findings was seen.

CONCLUSION: In our series, HP-eradication was ineffective for treatment of extragastric MALT lymphomas. This finding, along with an infection rate of 45%—as could also be expected in the general Austrian population—suggests that HP does not play a role in the development of these lymphomas. Antibiotic treatment targeting HP should, therefore, be discouraged in patients with extragastric MALT lymphomas.

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

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