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Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of marginal zone lymphoma belonging to the indolent non-Hodgkin lymphoma (NHL) entity.1 Histopathological markers of MALT lymphoma include the presence of lymphoepithelial lesions, follicular colonization and plasmacellular differentiation.2 Although MALT lymphoma can affect any organ, gastric presentation is responsible for up to 50% of all cases.2
The impact of initial depth of remission to first-line therapy on progression-free survival (PFS) in patients with gastric MALT lymphoma has not yet been established. Barbara Kiesewetter-Wiederkehr, Medical University of Vienna, AT, and colleagues investigated patient responses to first-line therapy and subsequent relapse patterns. The study which was published in Cancers in February placed a major focus on a sub cohort of patients that had received Helicobacter pylori (H. pylori) eradication therapy.2 The Lymphoma Hub hereby presents a summary of the results.
Chronic H. pylori gastritis has been associated with gastric MALT lymphomagenesis, and therefore H. pylori eradication is the standard of care (SoC) for patients with the condition.3 Antibiotic treatment demonstrates favorable outcomes in patients with gastric MALT lymphoma, inducing 5-year survival rates as high as 90%. However, follow-up biopsies uncover persistent disease in around one third of patients previously classed as being in complete remission (CR).2 It has been suggested that persisting or residual disease may be affected by the level of remission following first-line treatment. Uncovering a relationship between depth of remission and patient outcome may influence the clinical management of patients with gastric MALT lymphoma.2
Table 1. Baseline characteristics of gastric MALT lymphoma patient cohort
MALT-IPI, MALT lymphoma prognostic index; IQR, interquartile range *IE, confined to the stomach †IIE, presenting with local lymph node involvement ±IIIE, presenting with distant lymph node involvement §IV, disseminated disease |
|
Characteristic |
% of patients (n = 137) |
Sex, Female |
51 |
Median age, years (range) |
63 (22 – 85 years) |
Age ≥ 70 years |
28 |
Stage of disease-Ann Arbor Ann Arbor IE* Ann Arbor IIE† Ann Arbor IIIE± Ann Arbor IV§ |
66 23 1 10 |
MALT-IPI (available in 122 patients) Low risk Intermediate risk High risk |
62 33 6 |
Further clinical features Helicobacter pylori positive Plasmacellular differentiation Autoimmune disorder Paraproteinemia |
68 22 20 27 |
Median follow-up time, months (IQR) |
56.2 (26.3–111.6) |
Table 2. Front-line treatment approaches
H. pylori, Helicobacter pylori |
|
Treatment |
% of patients |
First-line treatment overall collective (N = 137) H. pylori eradication Systemic treatment (chemo-/immunotherapy) Local therapy (radiation, surgery) Watch and wait |
70 23 4 3 |
Table 3. Patient outcomes to first-line treatments
CR, complete remission; H. pylori, Helicobacter pylori; ORR, overall response rate; PD, progressive disease; PR, partial remission; SD, stable disease |
|||||
Response to treatment, % |
ORR |
CR |
PR |
SD |
PD |
Overall collective (n = 128)
|
67 |
48 |
19 |
30 |
3 |
H. pylori eradication therapy (n = 93)
|
58
|
38
|
20
|
39
|
3 |
Systemic treatment (n = 30) |
90
|
77
|
13
|
7
|
3 |
Local treatment (n = 5) |
100
|
80
|
20 |
- |
-
|
Table 4. Patient survival outcomes at a median follow-up of 56.2 months
CI, confidence interval; CR, complete response; H. pylori, helicobacter pylori; PFS, progression-free survival; PR, partial remission; SD, stable disease; TTNT, time to next treatment *This difference remained significant after multivariate correction for MALT-IPI factors |
||
Outcome |
Overall collective (N = 137) |
H. pylori eradication cohort (n = 96) |
Relapse/progression, % |
52 |
49 |
Median estimated PFS, months (95% CI) |
34.2 (16.0–52.4) |
27.6 (22.6–32.6) |
PFS, months Objective response Non-responders p |
68.3 17.3 < 0.001 |
49.0 17.3 < 0.001 |
Median estimated PFS CR vs PR, months CR PR p |
94.8 28.5 0.007 |
109.4 27.6 0.020* |
TTNT Objective response SD p |
47.5 15.3 0.001 |
30.3 15.4 0.008 |
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