From the Guidelines
Helicobacter pylori infection is directly related to the development of MALT lymphoma, and its eradication is the first-line treatment for early-stage gastric MALT lymphoma. The relationship between H. pylori infection and MALT lymphoma is well-established, with the bacteria triggering an inflammatory response that leads to the accumulation of lymphoid tissue in the gastric mucosa, which can eventually undergo malignant transformation into MALT lymphoma 1.
Key Points:
- H. pylori eradication therapy is the primary treatment for early-stage gastric MALT lymphoma, with a success rate of 70-80% 1.
- Standard eradication regimens typically include a proton pump inhibitor combined with antibiotics, such as amoxicillin and clarithromycin, for 14 days 1.
- Patients require endoscopic follow-up with biopsies at 3-6 month intervals to confirm lymphoma regression and H. pylori eradication 1.
- For patients with persistent lymphoma despite successful H. pylori eradication, additional treatments including radiation therapy or chemotherapy may be necessary 1. The most recent and highest quality study, published in 2013, supports the use of H. pylori eradication therapy as the first-line treatment for early-stage gastric MALT lymphoma 1.
Treatment Approach:
- H. pylori eradication therapy should be given to all gastric MALT lymphomas, independently of stage 1.
- Anti-helicobacter regimens combining proton-pump inhibitor plus clarithromycin-based triple therapy with either amoxicillin or metronidazole for 10–14 days are usually highly effective 1.
- The outcome of the eradication therapy should be checked by a urea breath test (or by a monoclonal stool antigen test) at least 6 weeks after eradication therapy and at least 2 weeks after PPI withdrawal 1.
From the Research
Relationship between H. Pylori Infection and MALT Lymphoma
- H. Pylori infection is strongly associated with low-grade gastric lymphoma, commonly known as mucosa-associated lymphoid tissue (MALT) lymphoma 2, 3, 4, 5, 6.
- The treatment for early stage H. pylori-positive gastric MALT lymphoma typically involves antibiotics to eradicate the H. pylori infection, which can lead to complete remission in a significant percentage of patients 4, 5, 6.
- Studies have shown that H. pylori eradication can result in complete remission of MALT lymphoma in 80% of early stage cases 3 and 85% of low-grade gastric MALT lymphoma cases 5.
- In cases where H. pylori infection is not present, alternative treatments such as rituximab may be effective 3.
- The relationship between H. pylori infection and MALT lymphoma is well-established, and eradication of the infection is a key component of treatment for this type of cancer 2, 4, 5, 6.