Anti-Helicobacter pylori therapy in localized gastric mucosa-associated lymphoid tissue lymphoma: A prospective, nationwide, multicenter study in Japan

Katsuya Sugizaki, Akira Tari, Yasuhiko Kitadai, Ichiro Oda, Shotaro Nakamura, Tadashi Yoshino, Toshiro Sugiyama, Katsuya Sugizaki, Akira Tari, Yasuhiko Kitadai, Ichiro Oda, Shotaro Nakamura, Tadashi Yoshino, Toshiro Sugiyama

Abstract

Background: Helicobacter pylori eradication therapy was approved in Japan for the first-line, standard treatment of H. pylori-positive gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Although several retrospective studies or small-scale single-center studies have been reported, a prospective, large-scale, nationwide, multicenter study has not been reported from Japan.

Materials and methods: We conducted a prospective, nationwide, multicenter study to evaluate the clinical efficacy of rabeprazole-based triple H. pylori eradication therapy for patients with localized gastric MALT lymphoma in practice-based clinical trial. A total of 108 H. pylori-positive patients with stage I/II1 gastric MALT lymphoma underwent H. pylori eradication therapy. The primary endpoints were complete remission (CR) rate and the rate of transfer to secondary treatment. The secondary endpoints were CR maintenance duration and overall survival (OS).

Results: CR of lymphoma was achieved in 84 of 97 patients (86.6%), during the period 2.0-44.7 months (median, 5.3 months) after starting H. pylori eradication treatment. CR was maintained in 77 of 81 patients (95.1%) for 0.4-53.2 months (median, 33.1 months). Secondary treatments (radiotherapy, rituximab, or gastrectomy) for gastric MALT lymphoma were needed in 10 of the 97 patients (10.31%). During follow-up, OS rate was 96.9% (94/97) and the causes of 3 deaths were not related to lymphoma.

Conclusions: Rabeprazole-based H. pylori eradication therapy demonstrated a high CR rate, long CR maintenance, and a good OS for patients with localized gastric MALT lymphoma in this prospective, practice-based, multicenter study.

Keywords: Helicobacter pylori eradication; gastric MALT lymphoma; prospective nationwide multicenter study; rabeprazole-based triple therapy.

© 2018 The Authors. Helicobacter Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Clinical courses of the 97 study patients. CR, complete remission
Figure 2
Figure 2
Kaplan‐Meier estimates of complete remission (CR) maintenance (relapse‐free) after achievement of CR

References

    1. Isaacson PG, Chott A, Nakamura S, et al. Extranodal marginal zone lymphoma of mucosa‐associated lymphoid tissue (MALT lymphoma) In: Swerdlow SH, Campo E, Harris NL, et al., eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th edn Lyon, France: IARC; 2008:214‐217.
    1. Isaacson P, Wright DH. Malignant lymphoma of mucosa‐associated lymphoid tissue. A distinctive type of B‐cell lymphoma. Cancer. 1983;52:1410‐1416.
    1. Wotherspoon AC, Doglioni C, Diss TC, et al. Regression of primary low‐grade B‐cell gastric lymphoma of mucosa‐associated lymphoid tissue type after eradication of Helicobacter pylori . Lancet. 1993;342:575‐577.
    1. Bayerdörffer E, Neubauer A, Rudolph B, et al. Regression of primary gastric lymphoma of mucosa‐associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group. Lancet. 1995;345:1591‐1594.
    1. Stolte M, Bayerdörffer E, Morgner A, et al. Helicobacter and gastric MALT lymphoma. Gut. 2002;50(suppl III):iii19‐iii24.
    1. National Comprehensive Cancer Network (NCCN) . NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) B‐cell Lymphomas Version 3. 2017.
    1. Zucca E, Copie‐Bergman C, Ricardi U, et al. Gastric marginal zone lymphoma of MALT type: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow‐up. Ann Oncol. 2013;24(Suppl 6):vi144‐vi148.
    1. Ruskoné‐Fourmestraux A, Fischbach W, Aleman BM, et al. ; EGILS group . EGILS consensus report. Gastric extranodal marginal zone B‐cell lymphoma of MALT. Gut. 2011;60:747‐758.
    1. Asaka M, Kato M, Takahashi S, et al. Guidelines for the management of Helicobacter pylori infection in Japan:2009 revised edition. Helicobacter. 2010;15:1‐20.
    1. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection –the Maastricht IV/Florence Consensus Report. Gut. 2012;61:646‐664.
    1. Chey WD, Leontiadis GI, Howden CW, et al. ACG Clinical Guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112:212‐238.
    1. Ono S, Kato M, Ono Y, et al. Characteristics of magnified endoscopic images of gastric extranodal marginal zone B‐cell lymphoma of the mucosa‐associated lymphoid tissue, including changes after treatment. Gastrointest Endosc. 2008;68:624‐631.
    1. Shiozawa E, Norose T, Kaneko K, et al. Clinicopathological comparison of the World Health Organization/Wotherspoon score to the Groupe d'Etude des Lymphomes de l'Adult grade for the post‐treatment evaluation of gastric mucosa‐associated lymphoid tissue lymphoma. J Gastroenterol Hepatol. 2009;24:307‐315.
    1. Rohatiner A, d'Amore F, Coiffier B, et al. Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol. 1994;5:397‐400.
    1. Nakamura S, Sugiyama T, Matsumoto T, et al. Long‐term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicentre cohort follow‐up study of 420 patients in Japan. Gut. 2012;61:507‐513.
    1. Copie‐Bergman C, Gaulard P, Lavergne‐Slove A, et al. Proposal for a new histological grading system for post‐treatment evaluation of gastric MALT lymphoma. Gut. 2003;52:1656.
    1. Wündisch T, Thiede C, Morgner A, et al. Long‐term follow‐up of gastric MALT lymphoma after Helicobacter pylori eradication. J Clin Oncol. 2005;23:8018‐8024.
    1. Hong SS, Jung HY, Choi KD, et al. A prospective analysis of low‐grade gastric MALT lymphoma after Helicobacter pylori eradication. Helicobacter. 2006;11:569‐573.
    1. Kim JS, Chung SJ, Choi YS, et al. Helicobacter pylori eradication for low‐grade gastric mucosa‐associated lymphoid tissue lymphoma is more successful in inducing remission in distal compared to proximal disease. Br J Cancer. 2007;96:1324‐1328.
    1. Wündisch T, Mösch C, Neubauer A, et al. Helicobacter pylori eradication in gastric mucosa‐associated lymphoid tissue lymphoma: results of a 196‐patient series. Leuk Lymphoma. 2006;47:2110‐2114.
    1. Stathis A, Chini C, Bertoni F, et al. Long‐term outcome following Helicobacter pylori eradication in a retrospective study of 105 patients with localized gastric marginal zone B‐cell lymphoma of MALT type. Ann Oncol. 2009;20:1086‐1093.
    1. Moleiro J, Ferreira S, Lage P, et al. Gastric malt lymphoma: analysis of a series of consecutive patients over 20 years. United European Gastroenterol J. 2016;4:395‐402.
    1. Zullo A, Hassan C, Cristofari F, et al. Effects of Helicobacter pylori eradication on early stage gastric mucosa‐associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol. 2010;8:105‐110.
    1. Sugiyama T, Asaka M, Nakamura T, et al. API2‐MALT1 chimeric transcript is a predictive marker for the responsiveness of H. pylori eradication treatment in low‐grade gastric MALT lymphoma. Gastroenterology. 2001;120:1884‐1885.
    1. Inagaki H, Nakamura T, Li C, et al. Gastric MALT lymphomas are divided into three groups based on responsiveness to Helicobacter pylori eradication and detection of API2‐MALT1 fusion. Am J Surg Pathol. 2004;28:1560‐1567.
    1. Pinotti G, Zucca E, Roggero E, et al. Clinical features, treatment and outcome in a series of 93 patients with low‐grade gastric MALT lymphoma. Leuk Lymphoma. 1997;26:527‐537.
    1. Savio A, Zamboni G, Capelli P, et al. Relapse of low‐grade gastric MALT lymphoma after Helicobacter pylori eradication: true relapse or persistence? Recent Results Cancer Res. 2000;156:116‐124.
    1. Nakamura T, Seto M, Tajika M, et al. Clinical features and prognosis of gastric MALT lymphoma with special reference to responsiveness to H. pylori eradication and API2‐MALT1 status. Am J Gastroenterol. 2008;103:62‐70.
    1. Andriani A, Miedico A, Tedeschi L, et al. Management and long‐term follow‐up of early stage H. pylori‐associated gastric MALT‐lymphoma in clinical practice: an Italian, multicentre study. Dig Liver Dis. 2009;41:467‐473.
    1. Weston AP, Banerjee SK, Horvat RT, et al. Prospective long‐term endoscopic and histologic follow‐up of gastric lymphoproliferative disease of early stage IE low‐grade B‐cell mucosa‐associated lymphoid tissue type following Helicobacter pylori eradication treatment. Int J Oncol. 1999;15:899‐907.
    1. Urakami Y, Sano T, Begum S, et al. Endoscopic characteristics of low‐grade gastric mucosa‐associated lymphoid tissue lymphoma after eradication of Helicobacter pylori . J Gastroenterol Hepatol. 2000;15:1113‐1119.
    1. Fischbach W, Goebeler‐Kolve ME, Dragosics B, et al. Long term outcome of patients with gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT) following exclusive Helicobacter pylori eradication therapy: experience from a large prospective series. Gut. 2004;53:34‐37.
    1. Terai S, Iijima K, Kato K, et al. Long‐term outcomes of gastric mucosa‐associated lymphoid tissue lymphomas after Helicobacter pylori eradication therapy. Tohoku J Exp Med. 2008;214:79‐87.
    1. Akamatsu T, Mochizuki T, Okiyama Y, et al. Comparison of localized gastric mucosa‐associated lymphoid tissue (MALT) lymphoma with and without Helicobacter pylori infection. Helicobacter. 2006;11:86‐95.

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