10-year follow up of 120 patients with gastric MALT lymphoma after Helicobacter pylori eradication—Histological residual disease and second cancers

Abstract

8536 Background: Helicobacter pylori (Hp) eradication induces lasting remissions in most patients with localized gastric MALT lymphoma (GML). The long term outcome of a prospective multicenter trial with special respect to second cancers and histological residual disease is presented. Methods: 120 patients with stage I1E disease were followed up for a median time of 122 (range 1-171) months. Histology was the standard for remission evaluation. Histological residual lymphoma (hRD) was diagnosed when normalization of macroscopic findings were persistent but in further follow-up biopsies histologic evidence of lymphoma was present. Prospective data concerning B-cell clonality were collected, the status of t(11;18) was evaluated in 65 patients in retrospect. Results: 80% (96/120) of patients achieved complete histological remission (CR), 80% (77/96) are in continuous complete histological remission (CCR) The estimated mean survival time in the Kaplan Meier analysis is 147 months (95% confidence interval, 138–156). 17% (16/96) of patients showed hRD during follow-up after a median time of 32 (range, 3–68) months, a watch-and-wait strategy was applied and all but one patient entered into a second CR. It is of note, that in 24 patients one or more secondary cancers were documented, 8 lymphomas and 21 solid tumors. Among these were 5 gastric cancers with the lymphoma being in CCR. Conclusions: Cure of Hp infection results in CCR in most patients. Secondary cancers are of concern in these patients. Histological residual disease, B-cell monoclonality, and t(11;18) were present in a considerable number of CR patients. Therefore, a watch-and-wait strategy seems to be justified, when close follow-up is guaranteed. No significant financial relationships to disclose.