Mucosa-associated Tissue Lymphoma Research Articles

Prevalence of Malaria and Helicobacter Pylori Coinfection and Associated Sociodemographic Factors among Blood Donors in Douala General Hospital

Background: The malaria parasite Plasmodium is intra-erythrocyte hence can be transmitted by transfusion of any blood component containing infected red blood cells. Helicobacter pylori infection affects more than half of the human population worldwide. Infection remains asymptomatic in most individuals, although some individuals develop acute gastritis, peptic or duodenal ulcers, gastric cancer, and mucosa associated tissue lymphoma. H. pylori infection have been implicated in some haematological manifestations such as anaemia and micronutrient deficiency. Objective: This research was designed to determine the prevalence of malaria parasitaemia and H. pylori coinfection in association with sociodemographic characteristics among donors in Douala General Hospital. Methodology: The study was a hospital-based study carried out from January to May 2022. The study population comprised of 106 donors who came to the hospital laboratory for blood donation. A structured questionnaire was used to get demographic and clinical data. Two ml of blood was collected from individuals to prepare a thick and thin blood film for malaria parasite determination and to centrifuge at 3000 rpm for 5 minutes to obtain plasma for H. pylori test strip. Results and Discussion: The overall prevalence of H. pylori in the study area was 70.8%. The female donors had a prevalence of 72.0%. A greater proportion of blood group O donors had H. pylori than groups A, AB and B but this difference was not significant (P-value = 0.571). The prevalence of malaria parasites infection was 36.8%. Those of blood group A had a higher prevalence rate of 42.3% (11/26). Out of the 106 donors, 23 (21.7%) had malaria and H. pylori coinfection. 68 (64.2%) donors had a mono-infection that is either having malaria mono-infection or H. pylori mono-infection and 15 (14.2%) had no infection. Malaria and H. pylori coinfection was higher in female donors than males (OR = 1.059, 95% Cl 0.359 -3.119, P =0.917), in donors aged below 25 years old (OR = 0.338, 95% Cl 0.075 - 1.535, P =0.160), replacement donors (OR = 1.350, 95% Cl 0.460 – 3.964, P =0.585); blood donors of blood group AB (OR = 0.654, 95% Cl 0.181 – 2.366, P =0.517) and Rhesus negative donors (OR = 1.500, 95% Cl 0.130 – 17.36, P =0.746). Conclusion: The prevalence of H. pylori infection and Malaria among blood donors in Douala General Hospital were high and coinfection was higher in females than males. Both malaria parasites and H. pylori infections have been implicated in blood parameters such as anaemia and micronutrient deficiency. It is therefore recommended that routine screening for malaria parasites and H. pylori be done in blood banks before transfusion for a high blood quality.

Current situation and risk factors for Helicobacter pylori eradication failure in Northwest China: a real-world evidence study.

Current situation and risk factors for Helicobacter pylori eradication failure in Northwest China: a real-world evidence study.

A federated AI strategy for the classification of patients with Mucosa Associated Lymphoma Tissue (MALT) lymphoma across multiple harmonized cohorts.

Mucosa Associated Lymphoma Tissue (MALT) type is an extremely rare type of lymphoma which occurs in less than 3% of patients with primary Sjögren's Syndrome (pSS). No reported studies so far have been able to investigate risk factors for MALT development across multiple cohort databases with sufficient statistical power. Here, we present a generalized, federated AI (artificial intelligence) strategy which enables the training of AI algorithms across multiple harmonized databases. A case study is conducted towards the development of MALT classification models across 17 databases on pSS. Advanced AI algorithms were developed, including federated Multinomial Naïve Bayes (FMNB), federated gradient boosting trees (FGBT), FGBT with dropouts (FDART), and the federated Multilayer Perceptron (FMLP). The FDART with dropout rate 0.3 achieved the best performance with sensitivity 0.812, and specificity 0.829, yielding 8 biomarkers as prominent for MALT development.

Gastric marginal zone lymphoma of mucosa-associated tissue and Epstein-Barr Virus associated lymphoepithelioma gastric carcinoma: Two primaries with an unusual metachronous presentation

Abstract Introduction/Objective Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) and Epstein-Barr virus (EBV) lymphoepithelioma gastric carcinoma, are two distinct gastric malignancies, with well-known clinicopathological characteristics. Synchronous or metachronous presentation of both entities in the same patient is extremely rare. Methods/Case Report We report a case of a 78-year-old woman, who presented with a 3 cm gastric body mass. Histologically, the biopsy showed H. pylori gastritis, with diffuse monotonous atypical lymphocytic cells and prominent lymphoepithelial lesions. CD20 immunostain was diffusely positive in these cells, supporting the diagnosis of MALT lymphoma. The patient was treated for H. pylorieradication, followed by Rituxan for resistant MALT lymphoma found in a surveillance biopsy. After being free of disease for one year, the patient developed a 2.0 cm, ulcerated lesion adjacent to the previous site. Biopsy of this lesion showed gastric mucosa with diffuse lymphoepithelial lesions, and atypical epithelial cells highlighted by pan-cytokeratin. The associated dense inflammatory infiltrate was comprised predominantly of CD3 T-lymphocytes. EBV was detected by in-situ hybridization (ISH) for EBV encoded RNA, and was positive in the epithelial cells, but negative in lymphocytes. These findings are consistent with EBV associated lymphoepithelioma carcinoma. Results (if a Case Study enter NA) NA Conclusion This case is presented due to its rarity, with only two cases reported previously, which invokes further research into the interaction between both infectious agents. Secondly, lymphoepithelial lesions are a common finding in both diseases, and in small biopsies, these entities can mask or mimic each other. EBV ISH and background B and T lymphocytes may be a clue and help in the diagnosis.

Primary gastric non-Hodgkin lymphomas: Recent advances regarding disease pathogenesis and treatment.

Primary gastric lymphomas (PGLs) are distinct lymphoproliferative neoplasms described as heterogeneous entities clinically and molecularly. Their main histological types are diffuse large B-cell lymphoma (DLBCL) or mucosa-associated lymphoma tissue. PGL has been one of the main fields of clinical research of our group in recent years. Although gastric DLBCLs are frequent, sufficient data to guide optimal care are scarce. Until today, a multidisciplinary approach has been applied, including chemotherapy, surgery, radiotherapy or a combination of these treatments. In this minireview article, we provide an overview of the clinical manifestations, diagnosis and staging of these diseases, along with their molecular pathogenesis and the most important related clinical published series. We then discuss the scientific gaps, perils and pitfalls that exist regarding the aforementioned studies, in parallel with the unmet need for future research and comment on the proper methodology for such retrospective studies. Aiming to fill this gap, we retrospectively evaluated the trends in clinical presentation, management and outcome among 165 patients with DLBCL PGL who were seen in our institutions in 1980-2014. The study cohort was divided into two subgroups, comparing the main 2 therapeutic options [cyclophosphamide doxorubicin vincristine prednisone (CHOP) vs rituximab-CHOP (R-CHOP)]. A better outcome with immunochemotherapy (R-CHOP) was observed. In the next 2 mo, we will present the update of our study with the same basic conclusion.

Prospectives of Helicobacter pylori

Helicobacter pylori (H. pylori) is a gram negative bacteria whose infection is highly prevalent among the human population and leads to gastrointestinal tract related diseases (gastric and duodenal ulcers, mucosa associated tissue lymphoma and gastric adenocarcinoma).Most people with H. pylori infection will never have any signs or symptoms. While this bacterium infects 50% of the world’s population, in Africa its prevalence reach as high as 80% as the infection is acquired during childhood. H. pylori eradication treatment is becoming more challenging due to increasing antimicrobial resistance. Treatment regimens are expected to overcome the in creasing prevalence of resistant strains of H. pylori and achieve a >90% eradication rate. Although treatment regimens provide acceptable H. pylori eradication rates, the regimens used should contribute to future resistance of H. pylori to antimicrobials and other therapies.

Contralateral Breast Diffuse Large B Cell Malignant Lymphoma With Previous MALT Lymphoma

Background: Breast involvement during malignant lymphomas is a rare condition, whether in primary or secondary cases, whereas according to the literature, primary breast lymphomas represents merely less than 0.5% of the breast malignancies.Case Presentation: The case was a 48 years-old patient referred to the clinic with contralateral breast diffuse large B cell malignant lymphoma. She had an operation for right breast mucosa-associated lymphoma tissue (MALT) lymphoma two-years earlier. The participant experienced surgical excision of the right breast mass and radiotherapy subsequently. Surprisingly, after two years she developed a mass on the left breast, for which we were not able to establish an evident relationship between the earlier MALT lymphoma and the second diffused B cell lymphoma.Conclusion: Although, our report emphasizes on the undeniable role of the breast examination in prevention of catastrophic events, we are far from providing diagnostic approaches on breast MALT lymphoma, due to minimal case sizes and lack of adequate information and evidences.

Review of current diagnostic methods and advances in Helicobacter pylori diagnostics in the era of next generation sequencing.

Helicobacter pylori (H. pylori) infection is highly prevalent in the human population and may lead to severe gastrointestinal pathology including gastric and duodenal ulcers, mucosa associated tissue lymphoma and gastric adenocarcinoma. In recent years, an alarming increase in antimicrobial resistance and subsequently failing empiric H. pylori eradication therapies have been noted worldwide, also in many European countries. Therefore, rapid and accurate determination of H. pylori’s antibiotic susceptibility prior to the administration of eradication regimens becomes ever more important. Traditionally, detection of H.pylori and its antimicrobial resistance is done by culture and phenotypic drug susceptibility testing that are cumbersome with a long turn-around-time. Recent advances in diagnostics provide new tools, like real-time polymerase chain reaction (PCR) and line probe assays, to diagnose H. pylori infection and antimicrobial resistance to certain antibiotics, directly from clinical specimens. Moreover, high-throughput whole genome sequencing technologies allow the rapid analysis of the pathogen’s genome, thereby allowing identification of resistance mutations and associated antibiotic resistance. In the first part of this review, we will give an overview on currently available diagnostic methods for detection of H. pylori and its drug resistance and their implementation in H. pylori management. The second part of the review focusses on the use of next generation sequencing technology in H. pylori research. To this end, we conducted a literature search for original research articles in English using the terms “Helicobacter”, “transcriptomic”, “transcriptome”, “next generation sequencing” and “whole genome sequencing”. This review is aimed to bridge the gap between current diagnostic practice (histology, rapid urease test, H. pylori culture, PCR and line probe assays) and new sequencing technologies and their potential implementation in diagnostic laboratory settings in order to complement the currently recommended H. pylori management guidelines and subsequently improve public health.

Small bowel mucosa‐associated lymphoid tissue lymphoma: A case report and literature review

Small intestine marginal B cell lymphoma of the mucosa‐associated type (MALT lymphoma) is relatively rare compared to gastric mucosa‐associated lymphoma tissue (MALT) lymphoma, and comprised only about less than 10% of primary small intestinal tumor cases. However, with advances in video capsule enteroscopy and balloon‐assisted enteroscopy, more cases of small bowel MALT lymphoma are expected to be discovered via endoscopy. The pathogenesis, endoscopic features, and treatment strategy, including Helicobacter pylori eradication therapy, remain an issue and require further clinical trial or studies to be resolved. Here, we report the case of a 67‐year‐old man with jejunal MALT lymphoma presenting with nearly total obstruction of his bowel lumen. He underwent segmental small bowel resection for the stricture without recurrence.

The impact of early diagnosis on the prognosis of extranodal NK/T-cell lymphoma with massive lung involvement: a case report

BackgroundPulmonary non-Hodgkin lymphoma (NHL) is rare. The most frequent subtype of pulmonary NHL is low-grade B-cell lymphoma, such as lymphoma of mucosa-associated lymphoma tissue. Extranodal natural killer cell/T-cell lymphoma, nasal type (ENKL) is characterized by predominant extranodal involvement and association with Epstein-Barr virus (EBV). ENKL with massive lung involvement has been infrequently reported, and its prognosis is extremely poor.Case presentationA 20-year-old Japanese man presented with intermittent fever lasting for 2 months. Radiological imaging demonstrated multiple nodules of uneven shape and size in both lungs. Video-assisted thoracic surgical lung biopsy showed abnormal lymphocyte infiltration, which was positive for CD3, CD56, and perforin. In situ hybridization for EBV-encoded RNA was positive. From these findings, he was diagnosed with ENKL with lung involvement. The patient was successfully treated with intensive combinational chemotherapy followed by allogeneic cord blood transplantation. He has been alive with continuous complete remission for 1 year after diagnosis.ConclusionsAlthough ENKL involving the lung has been reported to have dismal outcomes, our patient showed long-term survival after intensive chemotherapy and up-front allogeneic hematopoietic transplantation. The present case highlights the importance of early diagnosis as well as allogeneic transplantation.

One case of bilateral orbital mucosa-associated tissue lymphoma

One case of bilateral orbital mucosa-associated tissue lymphoma

Platelet to lymphocyte ratio (PLR) retains independent prognostic significance in advanced stage marginal zone lymphoma patients treated with rituximab, cyclophosphamide, vincristine, and prednisone combination chemotherapy (R-CVP): Consortium for Improving Survival of Lymphoma trial

BackgroundRituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP) is one of the effective chemotherapeutic regimens for patients with advanced stage marginal zone lymphoma (MZL). However, prognostic factors that affect the outcome of treatment for MZL are not well understood.MethodsBetween August 2006 and June 2013, patients with newly diagnosed stage III and IV MZL treated with R-CVP as a first-line therapy from 15 institutions were retrospectively analyzed. Patients' clinical and laboratory data at diagnosis were collected by review of medical records.ResultsA total of 80 patients were analyzed. Bone marrow involvement was observed in 30% cases. Twelve patients (15%) had nodal MZL, and 41.3% patients exhibited multiple mucosa-associated lymphoma tissue sites. Overall response rate was 91.3%, including 73.8% achieving complete response. Advanced MZL patients treated with R-CVP showed a 3-year progression-free survival (PFS) rate of 69.6%. Prognostic markers significantly affecting PFS in univariate analysis were platelet to lymphocyte ratio (PLR, <95 vs. ≥95, P=0.014), serum albumin (≤3.9 vs. >3.9 g/dL, P=0.008), and the International Prognostic Index (IPI) score (1 vs. 2–4, P=0.032). In multivariate analysis, only PLR (<95 vs. ≥95, HR 0.367, 95% CI, 0.139–0.971, P=0.043) was an independent risk factor for PFS.ConclusionPLR ≥95 at diagnosis is an independent prognostic marker for PFS in advanced stage MZL patients treated with R-CVP. This marker may aid clinicians in predicting the response to R-CVP chemotherapy in stage III and IV MZL patients.

Gastric mucosa-associated lymphoid tissue lymphoma and Helicobacter pylori infection: a review of current diagnosis and management.

Helicobacter pylori (H. pylori)-associated gastritis is one of the most common infectious diseases in the United States, China and worldwide. Gastric mucosa-associated tissue lymphoma (MALT lymphoma) is a rare mature B-cell neoplasm associated with H. pylori infection that is curable by antibiotics therapy alone. The pathological diagnosis of gastric MALT lymphoma can be reached by histological examination, immunohistochemical staining and B-cell clonality analysis. H. pylori eradication is the choice of therapy for early-stage gastric MALT lymphoma. High response rates and long-term survival have been reported in refractory and localized diseases treated with low-dose radiation therapy. Systemic chemotherapy is recommended for advanced-stage gastric MALT lymphoma and cases with large B-cell lymphoma transformation. Recent advances in the pathological diagnosis and management of gastric MALT lymphoma are reviewed in this article.

Serum 8 Hydroxydeoxyguanosine and Cytotoxin Associated Gene A as Markers for Helicobacter pylori Infection.

Helicobacter pylori (H.pylori) is associated with chronic gastritis, peptic ulcers, gastric adenocarcinomas and mucosa associated tissue lymphomas. Cytotoxin associated gene A (CagA) is one of the virulence factors of H.pylori. It is hypothesized that reactive oxygen species (ROS) play roles in H.pylori associated disease especially in development of gastric adenocarcinoma. Individuals infected with H.pylori bearing CagA produce more ROS than others. 8-hydroxydeoxyguanosine (8OHdG) is an in vitro marker of DNA damage and oxidative stress. The aim of this study was to investigate the relationship between 8OHdG level, H.pylori infection and CagA and alterations of serum 8OHdG level after H.pylori eradication. Patients admitted with dyspeptic complaints and upper gastrointestinal endoscopy were assessed. H.pylori was determined from histopathology of specimens. Serum 8OHdG levels of three groups (H.pylori negative, H. pylori positive CagA negative and H.pylori positive CagA positive) were compared. Patients with H.pylori infection received eradication therapy. Serum 8OHdG levels pretreatment and posttreatment were also compared. In total, 129 patients (M/F, 57/72) were enrolled in the study. Serum 8OHdG level of H.pylori negative, H. pylori positive CagA negative and H.pylori positive CagA positive groups were significantly different (5.77±1.35 ng/ml, 5.43±1.14 ng/ml and 7.57±1.25 ng/ml respectively, p=0.05). Furthermore, eradication therapy reduced serum 8OHdG level (6.10±1.54 ng/ml vs 5.55±1.23 ng/ml, p=0.05). Individuals infected with H.pylori bearing CagA strains have the highest serum 8OHdG level and eradication therapy decreases the serum 8OHdG level. To the best of our knowledge this is the first study that evaluated the effect of CagA virulence factor on serum 8OHdG level and the effect of eradication therapy on serum 8OHdG levels together. Eradication of CagA bearing H.pylori may prevent gastric adenocarcinoma by decreasing ROS. 8OHdG level may thus be a good marker for prevention from gastric adenocarcinoma.

Treatment Options for Extra-nodal Mucosa Associated Lymphoma Tissue (MALT) of the Stomach: Role of Radiation Therapy

Treatment Options for Extra-nodal Mucosa Associated Lymphoma Tissue (MALT) of the Stomach: Role of Radiation Therapy

Xerostomia.

Xerostomia is the subjective feeling of oral dryness. The major causes are Sjögren's syndrome (SS), medication and radiotherapy to the head and neck. SS is a chronic systemic autoimmune disease characterized by infiltration of the exocrine glands, the salivary and lacrimal ones in particular. The pathogenesis involves systemic B cell hyperactivity and T cell lymphocytes targeting glandular epithelial cells. About 7.5% of patients with SS develop malignant B cell lymphoma, mostly mucosa-associated tissue lymphomas. Certain classes of drugs can induce hyposalivation and/or xerostomia by, e.g., targeting neurotransmitters and receptors. As a result, amongst others the production of fluid and electrolytes in salivary glands can be reduced and the salivary composition can change. During head and neck radiotherapy, the administration of high doses to the major salivary glands, which are located in the periphery of the head, leads to progressive loss of glandular function and a diminished salivary output. Reduction of the dose and the volume of irradiated salivary glands by advanced radiotherapy techniques can be highly beneficial for patients.

The Revised International Prognostic Index (R-IPI) Score Is Predictive Of Survival In Aggressive Transformed Lymphomas (TL) From Low Grade Non-Hodgkin Lymphomas In The Chemoimmunotherapy Era

IntroductionHistologic transformation of low grade non Hodgkin lymphoma (LG-NHL) occurs with a variable frequency. Several factors have been associated with survival in transformed lymphoma (TL) and the prognosis has been generally poor. The R-IPI has been shown to be prognostic in the pre rituximab era. PurposeTo assess R-IPI as prognostic at lymphoma transformation in the rituximab era. MethodsPatients with a diagnosis of diffuse large B-cell lymphoma transformed from LG-NHL (DLBCL-TL) were identified between January 2001 and December 2011 through the Moffitt Cancer Center Total Cancer Care Database. LG-NHL included follicular lymphoma (FL), marginal zone lymphoma (MZL), mucosa associated tissue lymphoma (MALT) and other low grade histologies. Patients with small lymphocytic lymphoma (SLL) with Richter's transformation were excluded. All patients received rituximab based chemotherapy at transformation. Clinical data, pathologic data include morphology and immunohistochemistry (IHC) including CD10, BCL6, MUM1/IRF4 were recorded. Overall survival (OS) was calculated from the date of transformation. OS was estimated by the Kaplan-Meier method and compared using the long-rank test. A p-value< 0.05 was considered statistically significant. ResultsA total of 81 patients were identified with DLBCL-TL. At diagnosis and transformation the median ages were 60 and 64 years (22 – 89), respectively. The male:female ratio was 0.72. The most common LG-NHL diagnosis was FL (75.3%). The median time to DLBCL transformation (TTT) was 3.4 years. At LG-NHL diagnosis 67.9% of patients were stage III/IV, 23.5% had bulky disease, 35.8% had extranodal disease (ED) and 14.8% were FLIPI1 score > 3. At transformation 29.6% had B symptoms, 77.8% had stage III/IV disease, 25.9% had ED, and 40.4% had an elevated LDH. DLBCL-GCB as per Hans algorithm was present in 65.5% of cases at transformation. The mean hemoglobin (Hb) and serum albumin (SA) level at transformation were 12.6 g/dl and 3.9 g/dl, respectively and an IPI > 3 was present in 22.2% of cases. R-IPI categories were very good in 4.9%, good in 72.8% and poor in 22.2%. Patients received rituximab prior to transformation in 65.4% with R-CHOP being the most common regimen used (84%). Radioimmunotherapy (RIT) was given in 17.3% of patients. Patients received 3 or more treatment lines in 74.1%. Patients underwent autologous and allogeneic stem cell transplant in 24.7 and 2.5% of cases, respectively.The median OS was 6.2 years. Poorer OS was associated with R-IPI > 3 at transformation (median OS 1.9 y, HR 2.9 [CI 1.5 – 5.9], p<0.0001) (Figure 1), FLIPI1 score 3 or more (median OS 1.7y, HR 2.9 [CI 1.7 – 5.1], p<0.0001), TTT< 2 years (median OS 2.8y, HR 3.2 [0.9 – 10.5], p=0.041), B symptoms (median OS 2.8y, HR 3.1 [1.5 – 6.4] p=0.003) and elevated LDH (median OS 2.8y, HR 2.6[1 – 6.6], p=0.04). The median OS with IPI< 2 was not reached. No survival differences were seen with FL vs non FL histology, older age, extranodal disease, bulky disease, use of RIT, number of treatment lines or rituximab prior to TL. There was a trend towards poorer OS with SA< 3.7 g/dl (median OS 2.8y, p=0.068). [Display omitted] ConclusionsAn R-IPI >3 at transformation was associated with poorer OS in patients with LG-HNL who undergo histological transformation into DLBCL and treated with chemoimmunotherapy. This suggests that R-IPI can be used at the time of transformation to better assess the aggressiveness of disease. A confirmation of these findings will be needed in multicenter and prospective cohorts. Disclosures:No relevant conflicts of interest to declare.

A tailored health surveillance program unveils a case of MALT lymphoma in an HCV-positive health-care worker

Non-Hodgkin lymphoma (NHL) may occur among hepatitis C virus (HCV)-infected individuals. HCV is one of the most common blood-borne pathogens transmitted from patients to health-care workers (HCWs). The development of NHL among HCV-infected HCWs has recently been shown. To investigate this issue further a tailored health surveillance program was applied to 3,138 HCWs from four Medical Institutions. To this aim, all employees were screened for both anti-HCV antibodies and HCV-related extrahepatic manifestations. The HCV prevalence rate, similar among all the HCW subgroups, was 7.3%. The occurrence of a gastric mucosa-associated lymphoma tissue (MALT) lymphoma, diagnosed in a physician following a long history of HCV chronic infection, was observed. Molecular characterization of MALT tissue indicated that immunoglobuline gene combinations were those usually found among HCV-associated lymphomas. Furthermore, B-cell expansion exhibited t(14;18) translocation, as a genetic abnormality associated with the development of MALT lymphomas from HCV-positive patients. Overall, these findings support the hypothesis that HCV viral infection potentially affects the pathway of transformation and progression of lymphoma cells. The occurrence of B-cell NHL, among HCV-positive HCWs, is an additional reason to apply the standard precautions to reduce the risk of blood-borne pathogen transmission.

Mouse model of human mucosa associated lymphoma tissue (MALT) lymphoma

Mouse model of human mucosa associated lymphoma tissue (MALT) lymphoma

Bendamustine in lymphomas: a review of its use

BackgroundBendamustine is an alkylating agent recently approved in several European countries for non-Hodgkin's lymphoma (NHL) refractory to rituximab (R).PurposeTo describe bendamustine use in lymphomas and review safety in our clinical...