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DEPTH OF REMISSION FOLLOWING FIRST LINE HP‐ERADICATION IS AN INDEPENDENT PROGNOSTIC FACTOR IN GASTRIC MALT LYMPHOMA

Patients with gastric MALT lymphoma responding to initial HPeradication have an excellent outcome, and no further oncological therapy is recommended even in the presence of residual disease after antibiotic therapy due to excellent long term prognosis. However, no long term data exist on the influence of initial depth of remission (i.e. CR versus residual disease after response) on PFS in such patients. In view of this, we have retrospectively analysed the course of patients with gastric MALT lymphoma following initial treatment with focus on HP-eradication. In total, 137 patients with gastric MALT lymphoma (70 f / 67 m) were treated at our institution: 66% had stage I, 23% stage II while the remaining patients had disseminated disease. The MALT-IPI was 0 in 61%, 1 in 33%, 2 in 5% and 3 in 1% of cases. Out of those patients, 69% were found positive for HP, while 31% were negative by means of histology, breath test and serology. Consequently, 70% were given antibiotics for first line therapy, 24% systemic therapy and 4% local therapy; 4 patients were only watched and were excluded from this analysis. Response was assessed based on histology as defined in the GELA-criteria for no change, responding residual disease (rRD) and probable minimal residual disease (pMRD) as well as complete remission (CR) based on regular follow up biopsies every 3 months for the first two years after therapy and every 6 months afterwards. The median follow-up was 56 months for our cohort. In total, 67% responded to first line therapy as assessed by histology according to the GELA-criteria (48% CR, 19% PR including rRD and pMRD) as judged by best outcome, while 30% had stable disease/no change. Overall, the median PFS for all responders was 68 months and significantly better than for patients with stable disease/no change at 17 months (p < 0.01); furthermore, patients achieving CR had a significantly longer PFS at 95 months versus 29 months for the PR group (p = 0.01); and all differences remained significant after correction for MALT-IPI. Also among the subgroup of HPpositive patients undergoing eradication for first line therapy, the difference between CR and PR remained significant for PFS at 109 months vs 28 months (p = 0.02). However, in terms of overall survival, no difference between CR and PR after initial therapy could be demonstrated. These data suggest that patients with gastric MALT lymphoma achieving a CR after initial therapy, especially HP-eradication have a significantly longer PFS than patients with residual disease after initial response. In view of these results, patients with PR should probably be followed more closely than after CR.