Management of gastric mucosa-associated lymphoid tissue lymphoma in patients with extra copies of the MALT1 gene

doi:10.3748/wjg.v23.i33.6155

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World Journal of Gastroenterology

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Retrospective Study

World J Gastroenterol. Sep 7, 2017; 23(33): 6155-6163
Published online Sep 7, 2017. doi: 10.3748/wjg.v23.i33.6155

Management of gastric mucosa-associated lymphoid tissue lymphoma in patients with extra copies of the MALT1 gene

Masaya Iwamuro, Ryuta Takenaka, Masahiro Nakagawa, Yuki Moritou, Shunsuke Saito, Shinichiro Hori, Tomoki Inaba, Yoshinari Kawai, Tatsuya Toyokawa, Takehiro Tanaka, Tadashi Yoshino, Hiroyuki Okada

Masaya Iwamuro, Hiroyuki Okada, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan

Ryuta Takenaka, Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama 7080841, Japan

Masahiro Nakagawa, Department of Internal Medicine, Hiroshima City Hospital, Hiroshima 730-8518, Japan

Yuki Moritou, Department of Gastroenterology, Mitoyo General Hospital, Kanonji 7691695, Japan

Shunsuke Saito, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 7008511, Japan

Shinichiro Hori, Department of Gastroenterology, Shikoku Cancer Center, Matsuyama 791-0280, Japan

Tomoki Inaba, Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu 7608557, Japan

Yoshinari Kawai, Department of Gastroenterology, Onomichi Municipal Hospital, Onomichi 7228503, Japan

Tatsuya Toyokawa, Department of Gastroenterology, Fukuyama Medical Center, Fukuyama 7208520, Japan

Takehiro Tanaka, Department of Pathology, Okayama University Hospital, Okayama 700-8558, Japan

Tadashi Yoshino, Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan

Author contributions: Iwamuro M organized the report and drafted the article; Takenaka R, Nakagawa M, Moritou Y, Saito S, Hori S, Inaba T, Kawai Y and Toyokawa T collected the data; Tanaka T and Yoshino T critically revised the article for important intellectual content; Okada H approved the final article.

Institutional review board statement: This study was reviewed and approved by the Ethical Committee of the Okayama University Hospital, Okayama, Japan.

Informed consent statement: This study is a retrospective study using medical records, and personal information protection measures are appropriately established so that the informed consent of the subject can be exempted.

Conflict-of-interest statement: All of the authors declare that they have no conflicts of interest associated with this article.

Data sharing statement: No additional data are available.

Correspondence to: Masaya Iwamuro, MD, PhD, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan. pr145h2k@okayama-u.ac.jp

Telephone: +81-86-2357219 Fax: +81-86-2255991

Received: May 22, 2017
Peer-review started: May 22, 2017
First decision: June 22, 2017
Revised: July 21, 2017
Accepted: August 8, 2017
Article in press: August 8, 2017
Published online: September 7, 2017
Processing time: 110 Days and 11.6 Hours

Abstract

AIM

To identify the clinical features of gastric mucosa-associated lymphoid tissue (MALT) lymphoma with extra copies of MALT1.

METHODS

This is a multi-centered, retrospective study. We reviewed 146 patients with MALT lymphoma in the stomach who underwent fluorescence in situ hybridization analysis for t(11;18) translocation. Patients were subdivided into patients without t(11;18) translocation or extra copies of MALT1 (Group A, n = 88), patients with t(11;18) translocation (Group B, n = 27), and patients with extra copies of MALT1 (Group C, n = 31). The clinical background, treatment, and outcomes of each group were investigated.

RESULTS

Groups A and C showed slight female predominance, whereas Group B showed slight male predominance. Mean ages and clinical stages at lymphoma diagnosis were not different between groups. Complete response was obtained in 61 patients in Group A (69.3%), 22 in Group B (81.5%), and 21 in Group C (67.7%). Helicobacter pylori (H. pylori) eradication alone resulted in complete remission in 44 patients in Group A and 13 in Group C. In Group B, 14 patients underwent radiotherapy alone, which resulted in lymphoma disappearance. Although the difference was not statistically significant, event-free survival in Group C tended to be inferior to that in Group A (P = 0.10).

CONCLUSION

Patients with t(11;18) translocation should be treated differently from others. Patients with extra copies of MALT1 could be initially treated with H. pylori eradication, similar to patients without t(11;18) translocation or extra copies of MALT1.

Keywords: Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue; Gastric neoplasms; Esophagogastroduodenoscopy; t(11; 18) translocation; Trisomy 18

Core tip: We subdivided and retrospectively reviewed 146 patients with gastric MALT lymphoma into patients without t(11;18) translocation or extra copies of MALT1 (Group A, n = 88, 60.3%), patients with t(11;18) translocation (Group B, n = 27, 18.5%), and patients with extra copies of MALT1 (Group C, n = 31, 21.2%). Groups A and C exhibited similar clinical characteristics. Helicobacter pylori eradication alone resulted in complete remission in approximately half the patients in Group A and Group C. Consequently, patients with extra copies of MALT1 could be treated similar to patients without t(11;18) translocation or extra copies of MALT1.