Eradication of Helicobacter Pylori in the Management of Stage IE & IIE-1 Primary Low-Grade B Cell Lymphoma of Mucosa-Associated Lymphoid Tissue Type of The Stomach
- The patients must have histologically confirmed primary low-grade B-cell lymphoma of
MALT of the stomach which including the following types : diffuse small lymphocytic,
diffuse small cleaved, and some diffuse mixed small and large cell types by Working
Formulation (Harris NL et al. 1994)(20).
- The diagnosis of primary gastric lymphoma must fulfill the criteria of Dawson :
1. No enlargement of peripheral or mediastinal lymph node;
2. Peripheral blood smear revealing no leukemic or lymphomatous abnormalities;
3. Predominant of alimentary tract lesions with any adenopathy corresponding to
accepted lymphatic drainage route; and
4. No involvement of liver or spleen except by extension of contiguous disease .
- The monoclonality of B-cell must be confirmed by either immunohisto- chemistry
(light-chain restriction) or molecular technique (IgH rearrangement).
- The patient must have no prior chemotherapy or radiotherapy for his/her gastric
- Patients must have evaluable disease by endoscopy and the nodal status by computed
tomography. Endoscopic ultrasonography (EUS)* is optional and for reference only.
- H. pylori infection will be evaluated by the following tests: histology, rapid urease
test (CLO-test), and serology C13-urea breath test (UBT) and bacterial culture* are
optional and for reference only.
- The following will be considered to have H. pylori infection : at least two of the
following 3 tests show positive results, rapid urease test (CLO-test), histology and
- For C13-urea breath test, rapid urease test and histology to examine H. pylori,
the examination must be performed at least 4 weeks apart from the latest
antibiotics or non-steroid anti-inflammatory drug ingestion.
- Patients must have either stage IE or IIE-1 disease, according to an adaptation of
the Ann Abor staging system modified by Musshoff for primary extranodal lymphoma.
- Stage IE : lymphoma confined to the gastric wall without lymph node involvement.
- Stage IIE : localized involvement of one or more GI site(s) on one side of the
diaphragm with lymph node infiltration, any depth of lymphoma infiltration into the
- Stage IIE-1 : infiltration of adjacent lymph node.
- Patient must have signed the informed consent.
- Patients who have extensive gastrointestinal tract involvement are not eligible.
- Patients who have had previous history of extranodal lymphoma are not eligible.
- Patients who have disease beyond stage IIE-2: infiltration of regional lymph node,
e.g. paraaortic, renal hilar, retroperitoneal, mesenteric, or lymph node of
gastrosplenic ligment and of hepatoduodenal ligment are not eligible.
- Patients who had a history of allergic reaction to Amoxicillin and Erythromycin
/Clarithromycin are not eligible.
- Patients whose cardiopulmonary status not allow him/her to have repeat endoscopy are
- Patients who had prior surgery, chemo- or radiotherapy for their primary gastric
lymphoma are not eligible.
- Patients who had previous anti-H. pylori therapy are not eligible.