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Most patients with minimal histological residuals of gastric MALT lymphoma after successful eradication of Helicobacter pylori can be safely managed by a watch-and-wait strategy. Experience from a large international series
  1. Wolfgang Fischbach (med2-aschaffenburg{at}t-online.de)
  1. Medizinische Klinik II, Klinikum Aschaffenburg, Germany
    1. Mariele Goebeler- Kolve (goebeler_m{at}klinik.uni-wuerzburg.de)
    1. Dept. of Internal Medicine II, University of Würzburg, Germany
      1. Agnes Ruskone-Fourmestraux (ja.fourmestraux{at}noos.fr)
      1. Federation d'Hepato-Gastroenterologie, Hopital Saint Antoine, AP-HP, Paris, France
        1. Thomas Wündisch (wuendisc{at}med.uni-marburg.de)
        1. Dept. of Internal Medicine, University of Marburg, Germany
          1. Andreas Neubauer (neubauer{at}staff.uni-marburg.de)
          1. Dept. of Internal Medicine, University of Marburg, Germany
            1. Markus Raderer (markus.raderer{at}meduniwien.ac.at)
            1. Dept. of Internal Medicine, University of Vienna, Austria
              1. Antonella Savio (hso.anatomia-patologica{at}fatebenefratelli.it)
              1. Dept. of Surgical Pathology, Ospedale S. Orsola Fatebenefratelli, Brescia, Italy

                Abstract

                Background: Helicobacter pylori plays a decisive role in the pathogenesis of gastric MALT (mucosa associated lymphoid tissue) lymphoma, and eradication therapy is the established initial treatment of stage I disease. Patients with histologically minimal persisting lymphoma infiltrates after successful eradication of Helicobacter pylori are considered as treatment failures and referred to radiation, chemotherapy, immunotherapy or surgery. We here report that a watch-and-wait strategy may become the preferred management of these patients.

                Methods: 108 patients were selected out of a larger series of patients treated at various European institutions. They had a mean age of 51,6 (25-82) years and were all diagnosed to have gastric marginal zone B-cell lymphoma of MALT-type of stage I. Twelve months after successful Helicobacter pylori eradication and normalisation of the endoscopic findings lymphoma infiltrates were still present histologically (minimal histological residuals). They did not receive any oncological therapy but were regularly controlled clinically and by endoscopies with multiple biopsies.

                Results: Based on a follow-up of 42,2 (2-144) months 102 patients (94%) revealed a favourable course of disease. Of these, 35 patients (32%) were found to enter into late and continuous complete remission of lymphoma. In 67 patients (62%) the minimal histological residuals remained stable and no changes became evident. A local lymphoma progression was seen in four patients (5%), and one patient developed a high-grade lymphoma.

                Conclusion: In this series, most patients with minimal histological residuals of gastric MALT lymphoma after successful eradication of Helicobacter pylori reveal a favourable course of disease without any oncological treatment. A watch-and-wait strategy with regular endoscopic-bioptic controls appears to be safe and may become the approach of choice in this situation. However, a longer follow-up of patients is needed to definitely establish this assertion.

                • Helicobacter pylori eradication
                • MALT lymphoma
                • gastric
                • histological residuals

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