Korean J Med.
1999 Jul;57(1):84-91.
A clinical study and short-term outcame of low-grade gastric MALT lymphoma
Abstract
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Low-grade gastric MALT lymphoma arises from long-standing Helicobacter pylori(Hp) infection.
High remission rates for these lymphoma have been observed after H. pylori eradication. There
was debates on the optimal treatment of low-grade gastric MALT lymphoma. The purpose of this
study is to investigate clinical and endoscopic characteristics of primary low-grade gastric
MALT lymphoma and to assess short-term clinical outcome of various modalities of treatment.
METHODS
30 patients(14 male, 16 female, mean age 44.9 years, range 26-76, mean follow-up
22.9 months) with primary low-grade gastric MALT lymphoma, diagnosed at the Samsung Medical
Center from March 1995 to September 1998, were evaluated in a retrospective study. We evaluated
patient's presenting symptoms, endoscopic finding, Hp status, staging by Musshoff system, and
recurrence rate according to treatment mordalities.
RESULTS
The most common symptom is epigastric discomfort or pain(36.7%). Endoscopic
appearances of gastric MALT lymphoma shows the wide variation from mucosal thickening to overt
malignancy. The most common site of gastric MALT lymphoma is the gastric antrum and lower
body(9 and 6 patients). Histologically, 70% were found to be Hp infected. Of 21 Hp(+) patients,
11 patients were clinical stage IE and received Hp eradication by PPI-based triple regimens.
81.8%(9/11) showed complete remission. Among 11 patients, 6 patients studied by PCR. After Hp
eradication, 5 in 6 patients showed persistent IgH rearangement by PCR. The mean follow-up time
is 22.8 months(range 3 to 36 months), One patient, who showed complete histologic regression
during second endoscopy, relapsed MALT lymphoma after 6 months. The other one patient showed
no change of lymphoma and underwent surgery. 12 patients underwent surgical treatment and
showed no evidence of relapse. The mean follow-up time is 35.9 months. 2 patients received
chemotherapy with CHOP regimen and showed complete remission. The mean follow-up time is
6.7 months. 2 patients received radiotherapy and showed no evidence of relapse. The mean
follow-up time is 15 months. CONCLUSION: Our study shows that complete remission rate
after Hp eradication is as high as some studies recently reported. This suggest that Hp
eradication may be considered as first-line therapy of low-grade gastric MALT lymphoma of stage IE.