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Complete Remission of Primary High-Grade B-Cell Gastric Lymphoma After Cure of Helicobacter pylori Infection

From Medical Department I, Technical University of Dresden, Dresden; Medical Department II, Klinikum Aschaffenburg, Aschaffenburg; Medical Department I, Krankenhaus Neuperlach, Munich; Institute for Pathology, University of Würzburg, Würzburg; Medical Department, Virchow Klinikum, Humboldt University, Berlin; Centre for Internal Medicine, University of Marburg, Marburg; and Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany.

Supported in part by Deutsche Krebshilfe (grant no. 70-551-Ne1).Address reprint requests to Andrea Morgner, MD, Medical Department I, Technical University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany; email: andrea.morgner{at}t-online.de

PURPOSE: Treatment of low-grade gastric mucosa-associated lymphoid tissue lymphoma by eradication of Helicobacter pylori is reported to result in complete lymphoma remission in approximately 75% of cases. The effect that cure of the infection has on the course of a primary high-grade gastric lymphoma is largely uncertain. The aim of this study was to report the effect of cure of H pylori infection exerted in patients with high-grade B-cell gastric lymphoma.

PATIENTS AND METHODS: Eight patients (4 males and 4 females; age range, 26 to 85 years) with H pylori infection and high-grade lymphoma received eradication therapy before planned treatment. The effect of H pylori eradication on the course of high-grade lymphoma was assessed by analysis of surgical specimens (n = 2) or endoscopic biopsies (n = 6).

RESULTS: H pylori eradication was successful in all patients and led to complete remission of the lymphoma in seven patients. One patient has experienced partial remission. Two patients were referred to surgery, one of whom (stage II_1E) had lymph node involvement, and the histologic work-up of the resected stomach revealed residual infiltrates of a low-grade lymphoma, which prompted consolidation chemotherapy. In one patient (initially stage I_1E), abdominal lymphoma developed 6 months after eradication therapy, which regressed completely after chemotherapy. In four patients, no further treatment was given. Six patients continue in complete remission (range, 6 to 66 months).

CONCLUSION: Primary high-grade B-cell gastric lymphoma in stages I_E through II_E1 associated with H pylori may regress completely after successful cure of the infection. Prospective trials are needed to investigate this treatment in larger numbers of patients.

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