BACKGROUND: Eradication of Helicobacter pylori is the established initial treatment of stage I MALT (mucosa associated lymphoid tissue) lymphoma. Patients with minimal persisting lymphoma infiltrates after successful eradication of H pylori are considered treatment failures and referred for radiation, chemotherapy, immunotherapy, or surgery. AIM: To report a watch and wait strategy in such patients. METHODS: 108 patients were selected from a larger series of patients treated at various European institutions. Their mean age was 51.6 years (25 to 82), and they were all diagnosed as having gastric marginal zone B cell lymphoma of MALT type stage I. After successful H pylori eradication and normalisation of the endoscopic findings, lymphoma infiltrates were still present histologically at 12 months (minimal histological residuals). No oncological treatment was given but the patients had regular follow up with endoscopies and multiple biopsies. FINDINGS: Based on a follow up of 42.2 months (2-144), 102 patients (94%) had a favourable disease course. Of these, 35 (32%) went into complete remission. In 67 (62%) the minimal histological residuals remained stable and no changes became evident. Local lymphoma progression was seen in four patients (5%), and one patient developed a high grade lymphoma. CONCLUSIONS: Most patients with minimal histological residuals of gastric MALT lymphoma after successful eradication of H pylori had a favourable disease course without oncological treatment. A watch and wait strategy with regular endoscopies and biopsies appears to be safe and may become the approach of choice in this situation. Longer follow up is needed to establish this definitively.
BACKGROUND: Eradication of Helicobacter pylori is the established initial treatment of stage I MALT (mucosa associated lymphoid tissue) lymphoma. Patients with minimal persisting lymphoma infiltrates after successful eradication of H pylori are considered treatment failures and referred for radiation, chemotherapy, immunotherapy, or surgery. AIM: To report a watch and wait strategy in such patients. METHODS: 108 patients were selected from a larger series of patients treated at various European institutions. Their mean age was 51.6 years (25 to 82), and they were all diagnosed as having gastric marginal zone B cell lymphoma of MALT type stage I. After successful H pylori eradication and normalisation of the endoscopic findings, lymphoma infiltrates were still present histologically at 12 months (minimal histological residuals). No oncological treatment was given but the patients had regular follow up with endoscopies and multiple biopsies. FINDINGS: Based on a follow up of 42.2 months (2-144), 102 patients (94%) had a favourable disease course. Of these, 35 (32%) went into complete remission. In 67 (62%) the minimal histological residuals remained stable and no changes became evident. Local lymphoma progression was seen in four patients (5%), and one patient developed a high grade lymphoma. CONCLUSIONS: Most patients with minimal histological residuals of gastric MALT lymphoma after successful eradication of H pylori had a favourable disease course without oncological treatment. A watch and wait strategy with regular endoscopies and biopsies appears to be safe and may become the approach of choice in this situation. Longer follow up is needed to establish this definitively.
Authors: C Copie-Bergman; P Gaulard; A Lavergne-Slove; N Brousse; J F Fléjou; K Dordonne; A de Mascarel; A C Wotherspoon Journal: Gut Date: 2003-11 Impact factor: 23.059
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Authors: W Fischbach; B Dragosics; M E Kolve-Goebeler; C Ohmann; A Greiner; Q Yang; S Böhm; P Verreet; O Horstmann; M Busch; E Dühmke; H K Müller-Hermelink; K Wilms; S Allinger; P Bauer; S Bauer; A Bender; G Brandstätter; A Chott; C Dittrich; K Erhart; D Eysselt; H Ellersdorfer; A Ferlitsch; M A Fridrik; A Gartner; M Hausmaninger; W Hinterberger; K Hügel; P Ilsinger; K Jonaus; G Judmaier; J Karner; E Kerstan; P Knoflach; K Lenz; A Kandutsch; M Lobmeyer; H Michlmeier; H Mach; C Marosi; W Ohlinger; H Oprean; H Pointer; J Pont; H Salabon; H J Samec; A Ulsperger; A Wimmer; F Wewalka Journal: Gastroenterology Date: 2000-11 Impact factor: 22.682
Authors: Hongxiang Liu; Hongtao Ye; Agnes Ruskone-Fourmestraux; Daphne De Jong; Stefano Pileri; Christian Thiede; Anne Lavergne; Henk Boot; Giancarlo Caletti; Thomas Wündisch; Thierry Molina; Babs G Taal; Sabattini Elena; Togliani Thomas; Pier Luigi Zinzani; Andreas Neubauer; Manfred Stolte; Rifat A Hamoudi; Ahmet Dogan; Peter G Isaacson; Ming-Qing Du Journal: Gastroenterology Date: 2002-05 Impact factor: 22.682
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Authors: E Roggero; E Zucca; G Pinotti; A Pascarella; C Capella; A Savio; E Pedrinis; A Paterlini; A Venco; F Cavalli Journal: Ann Intern Med Date: 1995-05-15 Impact factor: 25.391
Authors: Richard W Tsang; Mary K Gospodarowicz; Melania Pintilie; Woodrow Wells; David C Hodgson; Alexander Sun; Michael Crump; Bruce J Patterson Journal: J Clin Oncol Date: 2003-11-15 Impact factor: 44.544
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Authors: Barry W Hancock; Wendi Qian; David Linch; Jean-Charles Delchier; Paul Smith; Ira Jakupovic; Cathy Burton; Robert Souhami; Andrew Wotherspoon; Christiane Copie-Bergman; Carlo Capella; Catherine Traulle; Michael Levy; Sergio Cortelazzo; Andres J M Ferreri; Achille Ambrosetti; Graziella Pinotti; Giovanni Martinelli; Umberto Vitolo; Franco Cavalli; Christian Gisselbrecht; Emanuele Zucca Journal: Br J Haematol Date: 2008-11-22 Impact factor: 6.998