Second Cancers and Residual Disease in Patients Treated for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma by Helicobacter pylori Eradication and Followed for 10 Years

Background & Aims Cure of Helicobacter pylori infection induces remission in most patients with gastric mucosa-associated lymphoid tissue lymphoma (GML) that is associated with these bacteria. We determined the long-term outcomes of these patients in a prospective multicenter trial and investigated whether they developed second cancers or had histologic residual disease. Methods We followed 120 patients with stage EI1 GML for a median of 122 months after H pylori eradication (range, 1–171 months). Remission was determined by histology analysis and development of second cancers was documented. Results Of the patients, 80% (96 of 120) achieved complete remission from GML, and 80% of those (77 of 96) remained disease free. Estimated mean survival time in the Kaplan–Meier analysis was 147 months (95% confidence interval: 138–156 months). Of the patients that achieved complete remission, 17% (16 of 96) had histologic residual disease after a median of 32 months (range, 3–68 months). Disease did not progress in any of these patients, and all but 1 achieved a second complete remission (median duration, 46 months). Standardized morbidity ratios revealed a significantly higher incidence of gastric cancer (8.567; 95% confidence interval, 3.566–20.582) or non-Hodgkin lymphoma (18.621; 95% confidence interval: 8.365–41.448) in the 96 patients that achieved a complete remission, compared with the general German population. Conclusions Cure of H pylori infection leads to continuous complete remission in most patients with H pylori –associated GML. Patients are at risk for development of secondary cancers (ie, gastric cancer and non-Hodgkin lymphoma).