Impaired response of gastric MALT-lymphoma to Helicobacter pylori eradication in patients with autoimmune disease

Abstract

Background and aims: Gastric MALT-lymphoma is though to be related to chronic antigenic stimulation provided by Helicobacter pylori (HP). As clonal expansion of gastric B cells not related to HP has been demonstrated in patients with autoimmune disease (AD), we have analysed whether AD adversely influences response of MALT-lymphoma following HP-eradication. Patients and methods: Retrospective analysis of all patients with early stage gastric MALT-lymphoma treated with HP-eradication was performed. The presence of AD was evaluated by personal questioning for specific symptoms and serologically by analysis of rheumatoid factor, antinuclear antibodies and thyroid autoantibodies. Results: A total of 22 patients were identified receiving only antibiotic treatment for initial management, and six presented with an autoimmune condition: three had Sjögren's syndrome, one polymyalgia rheumatica, one autoimmune thyroiditis along with psoriasis, and one patient had only autoimmune thyroiditis. Successful eradication of HP was achieved in all patients, and 15 of 22 patients (68%) achieved complete response of the lymphoma, while none out of the six patients with an autoimmune disorder responded to HP-eradication. Conclusion: Apart from questioning the role of HP in the development of lymphoma in such patients, these results suggest that patients with autoimmune disease might not be optimal candidates for HP-eradication even in case of early stage lymphoma.