Helicobacter pylori eradication therapy may be considered as an initial treatment option for some patients with H pylori-negative gastric mucosa-associated lymphoid tissue (MALT) lymphoma, according to a study in Helicobacter.
Researchers used electronic databases to conduct a literature search of studies published up to October 2019. The studies that reported treatment response to eradication therapy as an initial treatment for patients with H pylori-negative gastric MALT lymphoma were eligible for inclusion. The complete remission (CR) rate after eradication therapy was the primary outcome.
A total of 25 studies and 2485 patients with gastric MALT lymphoma were included in the meta-analysis; 16 studies were from Asian countries and 9 were from Western countries. The median number of patients with H pylori-negative MALT lymphoma considered in the studies was 14 (range, 3-131)
After eradication therapy in patients with H pylori-negative gastric MALT lymphoma, the CR rate was 29.3% (95% CI, 22.2%-37.4%). A moderate level of heterogeneity was observed in the included studies (I2 =41.5%).
The pooled CR rates were lower in the subgroups of studies that had a higher incidence of translocation t(11;18)(q21;q21). In these subgroups, the CR rate was 19.9% (95% CI, 11.6%-32.0%). The CR rate was also lower in those studies that used serologic tests to exclude H pylori infection (27.5%; 95% CI, 20.1%-36.4%) and those in which nonresponse to eradication therapy was determined less than 12 months following treatment (27.0%; 95% CI, 15.5%-42.7%).
After conducting meta-regression analysis, the study authors found that among the potential confounding factors — including geographic area, publication year, diagnostic methods for H pylori infection, and methodologic quality — none of the covariates was the reason for the heterogeneity associated with the pooled estimate of the CR rate. Overall, no evidence of publication bias was found.
“The overall pooled CR rate after eradication therapy was 29.3%, and the strength of the pooled estimate was robust in our meta-regression analysis,” the study authors commented. “Although the CR rate after eradication therapy is lower than that of chemotherapy or radiotherapy, our pooled analysis indicates that H. pylori eradication therapy may be an effective initial treatment option for a subset of patients with H. pylori-negative gastric MALT lymphoma.”
The investigators noted several limitations to their findings. All of the included studies were observational, although 3 were conducted using a prospective design. Furthermore, the number of patients in each study was relatively small.
“We also advocate a watch and wait strategy for patients who reveal no evidence of progression and can be closely monitored,” the researchers advised. “Further studies to identify subgroups of patients who may benefit from eradication therapy are warranted.”
Jung K, Kim DH, Seo HI, Gong EJ, Bang CS. Efficacy of eradication therapy in Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: a meta-analysis. Helicobacter. Published online January 5, 2021. doi:10.1111/hel.12774