| Theme |
Gastrointestinal Lymphoma -- Recent Advances in the Diagnosis and Management |
| Title |
Therapeutic Strategy for Helicobacter pylori Eradication in Therapy-resistant Gastric MALT Lymphoma |
| Author |
Taiji Akamatsu |
Endoscopy Center, Suzaka Prefectural Hospital, Nagano Prefectural Hospital Organization / Internal Medicine, Gastroenterology, Shinshu University School of Medicine |
| Author |
Hideharu Miyabayashi |
Internal Medicine, Matsumoto Hospital, National Hospital Organization |
| Author |
Tadanobu Nagaya |
Internal Medicine, Gastroenterology, Shinshu University School of Medicine |
| Author |
Tomoaki Suga |
Internal Medicine, Gastroenterology, Shinshu University School of Medicine |
| Author |
Kazuhisa Shimodaira |
Internal Medicine, Suzaka Hospital, Nagano Prefectural Hospital Organization |
| Author |
Hiroyoshi Ota |
Department of Biomedical Sciences, School of Health Sciences, Shinshu University School of Medicine |
| [ Summary ] |
It is well known that eradication therapy for Helicobacter pylori (H. pylori) is a suitable treatment for first line gastric MALT lymphoma therapy. However, 20 - 30 % of patients with gastric MALT lymphoma are not cured with H. pylori eradication therapy. If we encounter patients with eradication therapy-resistant gastric MALT lymphoma, second line therapy is required. However, a strategy for second line therapy has not been established. Low-dose (30 Gy) radiation therapy is thought to be the most useful procedure as a second choice therapy for localized gastric MALT lymphoma. Nevertheless, careful systemic follow-ups for distant involvement and surveillance of secondary malignancy in association with radiation therapy are required afterward. Chemotherapy with CHOP regimens, including rituximab, is useful for patients with extensive MALT lymphoma and/or transformation to diffuse large B-cell lymphoma. On the other hand, single-agent chemotherapy, using cyclophosphamide, is effective for localized and extensive gastric MALT lymphoma. However relapse after suspension of administration and the occurrence of secondary malignancy should be kept in mind. Surgical procedures are required when complications such as uncontrolled bleeding and perforations are observed. However this is not recommended because gastrectomies reduce the quality of life for patients. "Watch and wait" is recommended for elderly patients and patients with other severe diseases because MALT lymphoma is believed to be a slow growing disease. Monotherapy with rituximab has been reported to be effective for treatment of MALT lymphoma of the rectum, spleen, and skin. On the other hand, there have been no reports concerning the usefulness of this monotherapy. Rituximab has been studied for treatment of high volume patients with gastric MALT lymphoma. |