eradication of helicobacter pylori in the management of stage ie & iie-1 primary low-grade b cell lymphoma of maltoma

Conditions: MALT Lymphoma

Summary: to evaluate the therapeutic effectiveness of h. pylori eradication in stage ie \& iie-1 primary low-grade b cell lymphoma of malt of the stomach

to investigate the prevalence of h. pylori infection in patients with early stage of primary low-grade b cell lymphoma of malt of the stomach in taiwan. -to evaluate the therapeutic effectiveness of h. pylori eradication in stage ie \& iie-1 primary low-grade b cell lymphoma of malt of the stomach. to evaluate the efficacy of helicobacter pylori eradication therapy with respect to objective regression rate and time to disease progression of primary low-grade gastric maltoma. to estimate any differences in therapeutic efficacy related to different stage of disease,eg. stage ie v.s. stage iie-1. to identify the causes of treatment failure, such as the stage of tumor, the presence of large cell component, and/or persistent, reactivation or reinfection of h. pylori etc.

Eligibility criteria:
inclusion criteria: * 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 maltoma. * 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 serology. * 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 gut wall. * stage iie-1 : infiltration of adjacent lymph node. * patient must have signed the informed consent. exclusion criteria: * 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 not eligible. * 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.

Keywords: malt lymphoma diffuse large b-cell lymphoma, stomach helicobacter pylori antibiotic therapy