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.
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U2 - 10.7326/0003-4819-131-2-199907200-00003
DO - 10.7326/0003-4819-131-2-199907200-00003
M3 - Article
C2 - 10419446
AN - SCOPUS:0033587640
SN - 0003-4819
VL - 131
SP - 88
EP - 95
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 2
ER -