Steinbach, G., Ford, R., Glober, G., Sample, D., Hagemeister, F. B., Lynch, P. M., McLaughlin, P. W., Rodriguez, M. A., Romaguera, J. E., Sarris, A. H., Younes, A., Luthra, R., Manning, J. T., Johnson, C. M., Lahoti, S., Shen, Y., Lee, J. E., Winn, R. J., Genta, R. M., Graham, D. Y., Cabanillas, F. F., Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue. An uncontrolled trial.,
Annals of internal medicine, vol. 131 no. 2
(July, 1999),
pp. 88-95, ISSN 0003-4819
(last updated on 2011/02/11)
Abstract:
BACKGROUND: Gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is related to Helicobacter pylori infection and may depend on this infection for growth. OBJECTIVE: To determine the response of gastric MALT lymphoma to antibiotic treatment. DESIGN: Prospective, uncontrolled treatment trial. SETTING: University hospital referral center and three collaborating university and community hospitals. PATIENTS: 34 patients with stage I or stage II N1 gastric MALT lymphoma. INTERVENTION: Two of three oral antibiotic regimens--1) amoxicillin, 750 mg three times daily, and clarithromycin, 500 mg three times daily; 2)tetracycline, 500 mg four times daily, and clarithromycin, 500 mg three times daily; or 3) tetracycline, 500 mg four times daily, and metronidazole, 500 mg three times daily--were administered sequentially (usually in the order written) for 21 days at baseline and at 8 weeks, along with a proton-pump inhibitor (lansoprazole or omeprazole) and bismuth subsalicylate. MEASUREMENTS: Complete remission was defined as the absence of histopathologic evidence of lymphoma on endoscopic biopsy. Partial remission was defined as a reduction in endoscopic tumor stage or 50% reduction in the size of large tumors. RESULTS: 34 patients were followed for a mean (+/-SD) of 41 +/- 16 months (range, 18 to 70 months) after antibiotic treatment. Of 28 H. pylori-positive patients, 14 (50% [95% CI, 31% to 69%]) achieved complete remission, 8 (29%) achieved partial remission (treatment eventually failed in 4 of the 8), and 10 (36% [CI, 19% to 56%]) did not respond to treatment. Treatment failed in all 6 (100% [CI, 54% to 100%]) H. pylori-negative patients. Patients with endoscopic appearance of gastritis (stage I T1 disease) were most likely to achieve complete remission within 18 months. Tumors in the distal stomach were associated with more favorable response than tumors in the proximal stomach. CONCLUSIONS: A subset of H. pylori-positive gastric MALT lymphomas, including infiltrative tumors, may respond to antibiotics. The likelihood of early complete remission seems to be greatest for superficial and distal tumors.
Keywords:
Anti-Bacterial Agents* • Anti-Ulcer Agents • Bismuth • Drug Therapy, Combination • Gastroscopy • Helicobacter Infections • Helicobacter pylori* • Humans • Lymphoma, B-Cell, Marginal Zone • Neoplasm Staging • Omeprazole • Organometallic Compounds • Prospective Studies • Remission Induction • Salicylates • Stomach Neoplasms • complications* • drug therapy* • microbiology* • pathology • therapeutic use • therapeutic use*
