Long-Term Follow-Up of Gastric MALT Lymphoma After Helicobacter Pylori Eradication Thomas Wu ¨ndisch, Christian Thiede, Andrea Morgner, Astrid Dempfle, Annette Gu ¨nther, Hongxiang Liu, Hongtao Ye, Ming-Qing Du, Theo D. Kim, Ekkehard Bayerdörffer, Manfred Stolte, and Andreas Neubauer A B S T R A C T Purpose Cure of infection induces remissions in most patients with early stage Helicobacter pylori- (Hp) positive gastric MALT (mucosa-associated lymphoid tissue) lymphoma (GML). We tracked the long-term stability of remissions in this prospective, multicenter trial. Patients and Methods In 120 patients with stage I 1E disease, we performed sequential endoscopic-bioptic follow-up after Hp eradication and polymerase chain reaction of the rearranged immunoglob- ulin heavy chain gene. The status of t(11;18) was assessed in 65 patients. Results Median follow-up was 75 months (range, one to 116). Five-year survival was 90%. Eighty percent of patients (96 of 120) achieved complete histologic remission (CR). Eighty percent of CRs are in continuous complete histologic remission (CCR). Three percent of CR patients (three of 96) relapsed and were referred for alternative treatment. Seventeen percent of CR patients (16 of 96) showed histologic residual disease (RD) during follow-up; a watch-and- wait strategy was applied, and all entered into a second CR. After a median follow-up of 63 months, 14 of 52 analyzed patients reaching CR showed ongoing B-cell monoclonality. Fifteen percent of GMLs were t(11;18) positive. Both t(11;18) and ongoing monoclonality were associated with a significantly higher risk for no response or relapse (P =.004, P =.007), but also present in patients in CCR. Early gastric cancer was diagnosed in three cases during follow-up. Conclusion Cure of Hp infection results in CCR in most patients. Histologic RD, B-cell monoclonality, and t(11;18) were present in a considerable number of CR patients. A watch-and-wait strategy is justified when close follow-up is guaranteed. J Clin Oncol 23:8018-8024. © 2005 by American Society of Clinical Oncology INTRODUCTION Development of gastric MALT (mucosa as- sociated lymphoid tissue) and gastric MALT lymphoma (GML) is closely linked to Heli- cobacter pylori (Hp) infection. 1-5 Several studies indicate that Hp eradication induces regression of GML in most cases. 6-11 Be- cause of its obvious advantages over alter- native treatment strategies, eradication is currently widely used as the first-choice treatment option for Hp-positive, early- stage GML. Radiotherapy is an established salvage treatment. 12 B-cell monoclonality is a common find- ing at diagnosis and in follow-up biopsies with the lymphoma in complete histologic remis- sion (CR). 9,10,13 Interpretation of a monoclo- nal (MC) polymerase chain reaction (PCR) is difficult; so far, there are no conclusive data available regarding whether patients with on- going monoclonality experience a somewhat From the Klinik fu ¨ r Ha ¨ matologie, Onkologie und Immunologie, Klinikum der Philipps Universita ¨ t, Marburg; Medizinische Klinik und Poliklinik I, Universita ¨ tsklinikum Carl Gustav Carus, Dresden; Institut fu ¨ r Medizinische Biometrie und Epidemiologie, Philipps Universita ¨ t, Marburg; the Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge, England; and the Institut fu ¨ r Pathologie, Klinikum Bayreuth, Bayreuth, Germany. Submitted April 18, 2005; accepted July 25, 2005. Supported by the Deutsche Krebshilfe (grant 70 2251), the Gesellschaft fu ¨r Gastroenterologie in Bayern, Germany, and the Leukemia Research Fund, UK. Authors’ disclosures of potential con- flicts of interest are found at the end of this article. Address reprint requests to Thomas Wu ¨ ndisch, Klinikum der Philipps Universita ¨t, Klinik fu ¨ r Ha ¨ matologie, Onkologie und Immunologie, 35033 Marburg, Germany; e-mail: wuendisc@ med.uni-marburg.de. © 2005 by American Society of Clinical Oncology 0732-183X/05/2331-8018/$20.00 DOI: 10.1200/JCO.2005.02.3903 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 23  NUMBER 31  NOVEMBER 1 2005 8018