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Helicobacter pylori Eradication in Gastric: Mucosa-Associated Lymphoid: Tissue Lymphomas
- Carlos Montalban, MD;
- Daniel Boixeda, MD; and
- Carmen Bellas, MD
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TO THE EDITOR:
We read with interest the article by Roggero and coworkers [1] showing that eradication of Helicobacter pylori can induce regression of localized low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Their finding of histologic remission in 60% of the patients confirm the results Wotherspoon and colleagues found in a small series [2]. Roggero and colleagues also found that regression was a progressive process in 8 of their 15 patients. Clinical and histologic regression of low-grade MALT lymphoma is the first goal of therapy. However, more accurate molecular studies are needed to show cure with eradication of latent residual disease.
We have treated six patients who had localized low-grade gastric MALT lymphoma with therapy to eradicate H. pylori (amoxicillin, metronidazole, and omeprazole). We have recently published preliminary sequential histologic and molecular data derived from polymerase chain reaction (PCR) amplification of IgH gene with Fr2 and Fr3 V-region primer in four of these patients [3]. In all four cases, H. pylori was eradicated, and in three, histologic disappearance of the tumor was documented. However, in all three, a monoclonal lymphoid population was shown by PCR, indicating the persistence of lymphoma. After variable periods, the monoclonal population could no longer be shown in any patient.
Similar results have been observed in the updated series of Wotherspoon and colleagues [4]. Histologic regression of lymphoma [1] and disappearance of the monoclonal population indicate that definitive cure can be achieved but in some cases may be delayed. However, the ultimate fate of patients with residual monoclonal populations is unknown. Some are cured rapidly after treatment, but others require more time to be cured. In still others, the monoclonal population may progress to overt lymphoma. Alternatively, cured patients can be reinfected with H. pylori[3], and reinfection may eventually lead to reactivation of lymphoma. Therefore, all patients should be closely followed with sequential clinical, endoscopic, histologic, and molecular studies. Patients who have achieved histologic cure, even without molecular cure, should receive no other treatment unless unequivocal histologic relapse is evident.
We agree that H. pylori eradication should be the initial treatment for localized low-grade gastric B-cell MALT lymphoma. For a second step of treatment, as documented in a large recent series [5], surgery can achieve a 5-year survival rate of 100% in localized cases, with no additional survival advantage provided by chemotherapy. Although therapeutic results of this retrospective series must be evaluated with some caution, surgery seems to be better treatment for localized gastric MALT lymphomas that do not respond to eradication of H. pylori.
Carlos Montalban, MD
Daniel Boixeda, MD
Carmen Bellas, MD
Hospital Ramon y Cajal
Madrid, Spain
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
