Gastric MALT Lymphomas Prospective LY03 Randomized Cooperative Trial: Preliminary Results of the Molecular Follow-up
Reviewer: William Levin, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: December 10, 2001
Presenter: F. Bertoni
Presenter's Affiliation: Barts and The London, London
Type of Session: Scientific
BackgroundGastric MALT lymphoma is most commonly treated with antibiotic therapy directed at H. Pylori infection.
Previous studies have shown that eradication of H. pylori can cause complete regression of gastric MALTs.
In the current study, investigators wanted to know if the addition of chlorambucil chemotherapy is of benefit after completion of antibiotic therapy.
Materials and MethodsAll patients with gastric MALT lymphoma received antibiotic therapy.
Following treatment, all pts underwent endoscopy and biopsy.
Tissue biopsies were not only reviewed histologically, but also by molecular analysis (polymerase chain reaction).
Pts with a histologic CR were randomized to receive either chlorambucil or observation.
Results46 of 62 pts (74%) had a histologic CR.
Follow-up material was available for molecular analysis in 34 cases.
13 were randomized to chlorambucil, 11 to observation, and 10 had not been randomized.
14 patients failed to achieve a molecular CR.
One year after histologic CR, 17 pts were in mCR and 3 achieved mCR by 2 years.
At a median follow-up at 2 years, 14(41%) of pts are in mCR.
For the pts randomized to chlorambucil, 46%(6/13)
achieved mCR, versus 82%(9/11) in the control group.
Molecular relapse was seen in 17% of pts in the chlorambucil group and 44% in the observation group.
Author's ConclusionsLess than half of pts with gastric MALT are able to achieve a continuous molecular CR after antibiotic therapy.
The addition of chlorambucil to standard therapy does not appear to have a benefit.
Clinical/Scientific ImplicationsMolecular techniques may offer a more sensitive assessment of post-treatment therapy.
More effective therapies are needed in the treatment of gastric MALT lymphoma.
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