A clinical study and short-term outcame of low-grade gastric MALT lymphoma / 대한내과학회지

ABSTRACT

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.