Relatively little is known about the long-term outcome of patients with Helicobacter pylori (HP)-negative
gastric lymphoma of mucosa-associated lymphoid tissue (
MALT lymphoma) with
antibiotic therapy as sole management. We have analyzed all patients with HP-negative gastric
MALT lymphoma undergoing
antibiotic therapy as sole management of their disease. HP negativity was defined as negative histology, breath test and serology, and response to treatment, survival and long-term outcome was assessed together with clinico-pathological characteristics including t(11; 18) (q21; q21) translocation. Out of 97 patients with gastric
MALT lymphoma, 24 were HP-negative, and 13 (5 females and 8 males) underwent only
antibiotic management for initial
therapy. Eight had stage I and five were found to have stage II disease, with three patients suffering from an underlying
autoimmune disease.
Antibiotic therapy consisted of standard HP eradication regimens consisting of
clarithromycin in all patients, along with
metronidazole in seven and
amoxicillin in six plus a
proton-pump inhibitor. After a median follow-up of 95 months (42-, 181+), 12/13 patients are alive. Six patients with stage I disease achieved an objective response (five complete (CR) and one partial remission, 46 %), four had stable disease (lasting 11-27 months), and three progressed. All patients with stable disease received
chemotherapy, but only one patient due to clear cut progression. One patient relapsed 23 months after initial CR, and achieved a second CR with
antibiotics now lasting 87 months. These results indicate that a relevant percentage of patients with HP-negative gastric
MALT lymphoma may benefit from
antibiotic therapy and do not require additional oncological
therapies. Our data suggest that the remissions seen in these patients might be durable as evidenced by prolonged follow-up in our series.