Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori

a multicentre cohort follow-up study of 420 patients in Japan

Nakamura, Shotaro
Sugiyama, Toshiro
Matsumoto, Takayuki
Iijima, Katsunori
Ono, Shouko
Tajika, Masahiro
Tari, Akira
Kitadai, Yasuhiko
Matsumoto, Hiroshi
Nagaya, Tadanobu
Kamoshida, Toshiro
Watanabe, Norihiko
Chiba, Toshimi
Origasa, Hideki
Asaka, Masahiro

¹Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
²Department of Gastroenterology and Hematology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
³Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
⁴Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
⁵Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
⁶Division of Gastroenterology, Department of Internal Medicine, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
⁷Department of Medicine and Molecular Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
⁸Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan
⁹Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
¹⁰Division of Gastroenterology, Department of Internal Medicine, Hitachi General Hospital, Hitachi, Japan
¹¹Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
¹²Department of Gastroenterology and Hepatology, School of Medicine Iwate Medical University, Morioka, Japan
¹³Department of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
¹⁴Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Dr Shotaro Nakamura, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; [email protected]

Accepted July 29, 2011

Gut 61(4):p 507-513, April 2012. | DOI: 10.1136/gutjnl-2011-300495

Objective

A multicentre cohort follow-up study of a large number of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma was conducted to elucidate the long-term outcome of the disease after Helicobacter pylori eradication.

Methods

420 patients with gastric low-grade MALT lymphoma who had undergone successful H pylori eradication and been followed up for at least 3 years were registered from 21 participating institutes. Responders to treatment were defined as patients whose post-treatment biopsies showed complete histological response (ChR) or probable minimal residual disease (pMRD). Treatment failure was defined as the status of progressive disease or lymphoma relapse after ChR/pMRD.

Results

323 patients (77%) responded to H pylori eradication. A logistic regression analysis showed that absence of H pylori, submucosal invasion determined by endoscopic ultrasonography and t(11;18)/API2-MALT1 were independent predictors of resistance to H pylori eradication. During the follow-up periods ranging from 3.0 to 14.6 years (mean 6.5 years, median 6.04 years), the disease relapsed in 10 of 323 responders (3.1%) while progressive disease was found in 27 of 97 non-responders (27%). Thus, 37 of 420 patients (8.8%) were regarded as treatment failures. Of these 37 patients, transformation into diffuse large B cell lymphoma occurred in nine patients. Among the non-responders and relapsed patients, 17 patients were subjected to a ‘watch and wait’ strategy while 90 patients underwent second-line treatments including radiotherapy (n=49), chemotherapy (n=26), surgical resection (n=6), chemoradiotherapy (n=5), antibiotic treatment (n=2), rituximab monotherapy (n=1) or endoscopic resection (n=1). Probabilities of freedom from treatment failure, overall survival and event-free survival after 10 years were 90%, 95% and 86%, respectively. Cox multivariate analysis revealed endoscopic non-superficial type to be an independent prognostic factor for adverse freedom from treatment failure, overall survival and event-free survival.

Conclusions

The excellent long-term outcome of gastric MALT lymphoma after H pylori eradication was confirmed by this large-scale follow-up study.