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Sequential H. pylori eradication and radiation therapy with reduced dose compared to standard dose for gastric MALT lymphoma stages IE & II1E: a prospective randomized trial

  • Original Article—Alimentary Tract
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Abstract

Background

In Helicobacter pylori (H. pylori) positive stage I gastric low-grade MALT lymphoma, eradication is the accepted first-line therapy. The role of eradication therapy in lymphoma > stage IE is still unclear. However, about 20% of patients show persistent lymphoma following successful eradication or primary H. pylori-negative lymphoma. A prospective study for salvage radiation therapy with standard 36 Gy in comparison to a reduced dose of 25.2 Gy is still missing.

Methods

A prospective, multicentre study investigated the efficacy of eradication in H. pylori-positive gastric low-grade MALT lymphoma stages IE and II1E (HELYX I). Refractory lymphoma or H. pylori-negative patients were treated in a prospective, randomised, multicentre, phase II study to receive either 25.2 Gy or 36 Gy radiotherapy (HELYX II).

Results

102 patients (3 drop outs) were included in HELYX I: 75/99 (75.8%) showed complete remission after a median of 2.8 months. 18 (18.2%) had partial remission (PR) and 6 (6.0%) no change (NC). 29 patients (7 drop outs) were randomized in HELYX II (7 primarily H. pylori-negative, 15 patients from HELYX I with refractory disease after eradication). All patients achieved stable CR irrespective of radiation dose. Both presence of the t(11,18) translocation (OR 9.0, p = 0.01) and monoclonality of the tumour cells (OR 6.3, p = 0.006) were predictors for persistant lymphoma after eradication therapy.

Conclusions

Most H. pylori-positive low grade gastric MALT lymphoma stage IE and II1E respond with stable CR after eradication therapy. In patients with refractory disease or H. pylori negative low grade gastric MALT lymphoma a dosage-reduced radiation therapy with 25.2 Gy is an effective standard dose in stage IE and II1E.

Trial registration

ClinicalTrials.gov: NCT00154440.

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Acknowledgements

This paper is dedicated to Professor Brigitte Dragosics and her enthusiasm for gastric lymphomas.

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Authors and Affiliations

  1. Medical Departement 1, University Hospital Carl Gustav Carus, Technical University, Fetscherstr. 74, 01307, Dresden, Germany

    Renate Schmelz, Christian Thiede, Stefan Brueckner & Jochen Hampe

  2. Center for Digestive Diseases, Cooperation of Internal Medicine, Hamburg, Germany

    Stephan Miehlke

  3. Department of Radiation Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany

    Monic Dawel & Christina Jentsch

  4. Institute for Medical Informatics and Biometry, Technical University, Dresden, Germany

    Matthias Kuhn

  5. Service de Gastroentérologie, St Antoine Hospital, Paris, France

    Agnes Ruskoné-Formestraux

  6. Institute for Pathology, Hospital Kulmbach, Kulmbach, Germany

    Manfred Stolte

  7. University Hospital Hamburg-Eppendorf, Center for Oncology and University Cancer Center Hamburg (UCCH), Hamburg, Germany

    Andrea Morgner

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  1. Renate Schmelz
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Correspondence to Renate Schmelz.

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Schmelz, R., Miehlke, S., Thiede, C. et al. Sequential H. pylori eradication and radiation therapy with reduced dose compared to standard dose for gastric MALT lymphoma stages IE & II1E: a prospective randomized trial. J Gastroenterol 54, 388–395 (2019). https://doi.org/10.1007/s00535-018-1517-4

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  • DOI: https://doi.org/10.1007/s00535-018-1517-4

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