Antibiotic Treatment of Gastric Lymphoma of Mucosa-Associated Lymphoid Tissue: An Uncontrolled Trial

  1. Gideon Steinbach, MD, PhD;
  2. Richard Ford, MD, PhD;
  3. Gary Glober, MD;
  4. Dory Sample, RN;
  5. Frederick B. Hagemeister, MD;
  6. Patrick M. Lynch, MD, JD;
  7. Peter W. McLaughlin, MD;
  8. Maria A. Rodriguez, MD;
  9. Jorge E. Romaguera, MD;
  10. Andreas H. Sarris, MD, PhD;
  11. Anas Younes, MD;
  12. Rajyalakshmi Luthra, PhD;
  13. John T. Manning, MD;
  14. Constance M. Johnson, BSN;
  15. Sandeep Lahoti, MD;
  16. Yu Shen, PhD;
  17. Jeffrey E. Lee, MD;
  18. Rodger J. Winn, MD;
  19. Robert M. Genta, MD;
  20. David Y. Graham, MD; and
  21. Fernando F. Cabanillas, MD
  1. From The University of Texas, M.D. Anderson Cancer Center, and Houston Veterans Affairs Medical Center, Houston, Texas.

    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.

    Article and Author Information

    • Grant Support: By National Cancer Institute grant RO1 CA67540-0 2 and Cancer Center Support grant CA-16672.

    • Requests for Reprints: Gideon Steinbach, MD, PhD, Department of Gastrointestinal Medical Oncology and Digestive Diseases, The University of Texas, M.D. Anderson Cancer Center, Box 78, 1515 Holcombe Boulevard, Houston, TX 77030; e-mail, gsteinb{at}aol.com.

    • Current Author Addresses: Drs. Steinbach, Ford, Glober, Hagemeister, Lynch, McLaughlin, Rodriguez, Romaguera, Sarris, Younes, Luthra, Manning, Lahoti, Shen, Lee, Winn, and Cabanillas, Ms. Sample, and Ms. Johnson: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.

    • Drs. Genta and Graham: Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030.

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    1. Ann Intern Med July 20, 1999 vol. 131 no. 2 88-95
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