2691 Quadruple Therapy: A Cure for Gastric High Grade B-Cell Lymphoma?

Abstract

INTRODUCTION: H. pylori contributes to approximately 75 % of stomach cancers internationally. Gastric MALT lymphoma is a rare disease with an incidence of 0.38 per 100,000 people in the United States of America (USA). The majority of gastric MALT lymphoma cases are cured with H pylori eradication therapy while chemotherapy is the mainstay of treatment for gastric diffuse large B-cell lymphoma (DLBCL). Gastric high grade DLBCL is rare and there is limited data in which treatment with H pylori eradication can attain complete remission. We present a case of a woman with DLBCL and was treated for H pylori and attained complete remission. CASE DESCRIPTION/METHODS: A 59 year old woman presented to our clinic for evaluation of epigastric pain for 2 months. A trial of Prior proton pump inhibitor (PPI) treatment did not improve her pain. Abdominal CT imaging was significant only for diverticulosis. Esophagogastroduodenoscopy (EGD) showed a 25 mm non-bleeding cratered gastric ulcer with pigmented material at the incisura of the stomach. Incisiural biopsies revealed high grade B cell lymphoma and antral/body biopsies showed H pylori. PET CT imaging showed diffuse fluorodeoxyglucose uptake along the lesser curvature of the stomach corresponding to the known area of lymphoma. There was no evidence of metastatic disease. The patient declined chemotherapy due to fear of associated side effects. Instead, she was given H pylori quadruple therapy with a 14 day course of Pantoprazole, Bismuth subsalicylate, Metronidazole, and Tetracycline. Repeat EGD with endoscopic ultrasound at 1 and 4 months later were unremarkable and biopsies at the site of the healed ulcer were negative for neoplasia. To date, she remains asymptomatic. DISCUSSION: To date, there is no established standard management strategy for primary gastric lymphoma. Major guidelines recommend chemotherapy as the initial treatment for DLBCL. The efficacy of HP eradication for gastric pure DLBCL has mostly remained unknown, with limited data available. Despite histological remission, lymphoma recurrence is possible. Given the limited data available, long term, careful follow-up should be done for all patients if they are treated with antibiotics for DLBCL.