Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue

An uncontrolled trial

Gideon Steinbach, Richard Ford, Gary Glober, Dory Sample, Frederick B. Hagemeister, Patrick M. Lynch, Peter W. McLaughlin, Maria A. Rodriguez, Jorge E. Romaguera, Andreas H. Sarris, Anas Younes, Rajyalakshmi Luthra, John T. Manning, Constance M. Johnson, Sandeep Lahoti, Yu Shen, Jeffrey E. Lee, Rodger J. Winn, Robert M. Genta, David Y. Graham & 1 others Fernando F. Cabanillas

Research output: Contribution to journalArticle

209 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)88-95
Number of pages8
JournalAnnals of Internal Medicine
Volume131
Issue number2
StatePublished - Jul 20 1999

Fingerprint

Marginal Zone B-Cell Lymphoma
Gastric Mucosa
Anti-Bacterial Agents
Helicobacter pylori
Neoplasms
Clarithromycin
Tetracycline
Stomach
Therapeutics
Lansoprazole
Omeprazole
Proton Pump Inhibitors
Amoxicillin
Community Hospital
Metronidazole
Helicobacter Infections
Gastritis
Familial primary gastric lymphoma
Lymphoma
Referral and Consultation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Steinbach, G., Ford, R., Glober, G., Sample, D., Hagemeister, F. B., Lynch, P. M., ... Cabanillas, F. F. (1999). Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue: An uncontrolled trial. Annals of Internal Medicine, 131(2), 88-95.

Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue : An uncontrolled trial. / Steinbach, Gideon; Ford, Richard; Glober, Gary; Sample, Dory; Hagemeister, Frederick B.; Lynch, Patrick M.; McLaughlin, Peter W.; Rodriguez, Maria A.; Romaguera, Jorge E.; Sarris, Andreas H.; Younes, Anas; Luthra, Rajyalakshmi; Manning, John T.; Johnson, Constance M.; Lahoti, Sandeep; Shen, Yu; Lee, Jeffrey E.; Winn, Rodger J.; Genta, Robert M.; Graham, David Y.; Cabanillas, Fernando F.

In: Annals of Internal Medicine, Vol. 131, No. 2, 20.07.1999, p. 88-95.

Research output: Contribution to journalArticle

Steinbach, G, Ford, R, Glober, G, Sample, D, Hagemeister, FB, Lynch, PM, McLaughlin, PW, Rodriguez, MA, Romaguera, JE, Sarris, AH, Younes, A, Luthra, R, Manning, JT, Johnson, CM, Lahoti, S, Shen, Y, Lee, JE, Winn, RJ, Genta, RM, Graham, DY & Cabanillas, FF 1999, 'Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue: An uncontrolled trial', Annals of Internal Medicine, vol. 131, no. 2, pp. 88-95.
Steinbach G, Ford R, Glober G, Sample D, Hagemeister FB, Lynch PM et al. Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue: An uncontrolled trial. Annals of Internal Medicine. 1999 Jul 20;131(2):88-95.
Steinbach, Gideon ; Ford, Richard ; Glober, Gary ; Sample, Dory ; Hagemeister, Frederick B. ; Lynch, Patrick M. ; McLaughlin, Peter W. ; Rodriguez, Maria A. ; Romaguera, Jorge E. ; Sarris, Andreas H. ; Younes, Anas ; Luthra, Rajyalakshmi ; Manning, John T. ; Johnson, Constance M. ; Lahoti, Sandeep ; Shen, Yu ; Lee, Jeffrey E. ; Winn, Rodger J. ; Genta, Robert M. ; Graham, David Y. ; Cabanillas, Fernando F. / Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue : An uncontrolled trial. In: Annals of Internal Medicine. 1999 ; Vol. 131, No. 2. pp. 88-95.
@article{6863d4c171594a209e64ac973a4cad81,
title = "Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue: An uncontrolled trial",
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.",
author = "Gideon Steinbach and Richard Ford and Gary Glober and Dory Sample and Hagemeister, {Frederick B.} and Lynch, {Patrick M.} and McLaughlin, {Peter W.} and Rodriguez, {Maria A.} and Romaguera, {Jorge E.} and Sarris, {Andreas H.} and Anas Younes and Rajyalakshmi Luthra and Manning, {John T.} and Johnson, {Constance M.} and Sandeep Lahoti and Yu Shen and Lee, {Jeffrey E.} and Winn, {Rodger J.} and Genta, {Robert M.} and Graham, {David Y.} and Cabanillas, {Fernando F.}",
year = "1999",
month = "7",
day = "20",
language = "English (US)",
volume = "131",
pages = "88--95",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "2",

}

TY - JOUR

T1 - Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue

T2 - An uncontrolled trial

AU - Steinbach, Gideon

AU - Ford, Richard

AU - Glober, Gary

AU - Sample, Dory

AU - Hagemeister, Frederick B.

AU - Lynch, Patrick M.

AU - McLaughlin, Peter W.

AU - Rodriguez, Maria A.

AU - Romaguera, Jorge E.

AU - Sarris, Andreas H.

AU - Younes, Anas

AU - Luthra, Rajyalakshmi

AU - Manning, John T.

AU - Johnson, Constance M.

AU - Lahoti, Sandeep

AU - Shen, Yu

AU - Lee, Jeffrey E.

AU - Winn, Rodger J.

AU - Genta, Robert M.

AU - Graham, David Y.

AU - Cabanillas, Fernando F.

PY - 1999/7/20

Y1 - 1999/7/20

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0033587640&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033587640&partnerID=8YFLogxK

M3 - Article

VL - 131

SP - 88

EP - 95

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 2

ER -