Helicobacter pylori Eradication Therapy, the Reasonable First Line Therapy for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Irrespective of Infection Status and Disease Stages

It seems very interesting and also strange that a malignant disease can be treated with antibiotics and acid suppressant combination therapy, rather than chemotherapy or radiotherapy. Infectious agents such as hepatitis B virus and hepatitis C virus, Epstein-Barr virus, Helicobacter pylori, and herpes simplex virus are well known causative agents for chronic inflammation associated cancers including hepatocellular carcinoma, stomach cancer, and cervical cancer. Even though the very early event of carcinogenesis starts from the chronic persistent infection status , once established cancers must be treated with chemo-and radiotherapy. Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is the only exception from the rules. Gastric MALT lymphoma is a shortened name of extranodal marginal zone B cell lymphoma of mucosa associated lymphoid tissue of stomach and typically a low-grade malignancy. In addition to B cell monoclonality, this is characterized by a dense lymphoid infiltrate mainly composed of small-size lymphocytes that invade and destroy the gastric epithelium, configuring the lymphoepithelial lesion which is pathognomonic of MALT lym-phoma diagnosis. 1 The discovery of the strong relationship between H. pylori infection and gastric MALT lymphoma naturally suggested H. pylori eradication to treat lymphoma. The effectiveness of eradi-cation has been well accepted and both hematology and gas-troenterology international guidelines currently advise H. pylori eradication as first-line therapy for gastric MALT lymphoma. It is more interesting that H. pylori eradication therapy is also indicated as a first line to H. pylori negative gastric MALT lym-phoma and lymphoma in advanced stage. The article by Gong et al., 5 titled as " Helicobacter pylori eradi-cation therapy is effective as the initial treatment for patients with H. pylori-negative and disseminated gastric mucosa-associated lymphoid tissue lymphoma " provides an additional evidence for this interesting clinical phenomenon. A total of 345 cases of gastric MALT lymphoma who had received eradica-tion therapy as their first line treatment were enrolled by using medical record retrospectively. H. pylori positivity was 91.9% and H. pylori eradication therapy achieved complete remission in 82.3% for H. pylori-positive patients and 57.1% for H. pylori-negative patients (p=0.001). In this study, investigators claimed that the complete remission rates were comparable, 74.4% for stage IE2 or above and 83.3% for stage IE1 disease after administration of H. pylori eradication treatment (p=0.167). Because H. pylori negative patients were relatively small in number (28/345) and patients in stage IE2 or above also occupied a limited proportion (39/345), degree of effectiveness of H. pylori eradication on …