MALT Lymphoma of Stomach When H. pylori Eradication Therapy Did Not Achieve Remission

This protocol addresses gastric MALT lymphoma that has persisted after first-line H. pylori eradication therapy — a situation in which the core endpoints of bacterial clearance, macroscopic lesion regression, and histological remission of the gastric mucosa were not achieved.

Previous line — failure condition

First-line H. pylori eradication therapy (clarithromycin-based triple therapy or bismuth-based quadruple therapy) did not meet the required endpoints: confirmed H. pylori eradication on urea breath test at least six weeks after treatment cessation, regression of macroscopic gastric lesions on control endoscopy, and histological regression of lymphocytic infiltration of the gastric mucosa. Failure to reach these goals escalates management to this second-line protocol.

Second-line approach — partial overview

For localized gastric MALT lymphoma persisting after eradication therapy, a locoregional radiation-based approach directed at the involved site is an established option. The full protocol specifies the applicable parameters, patient selection criteria, and clinical sequencing.

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References

DOI: 10.3390/cancers15153811

In case of persistence of GML after H. pylori eradication, and if the "watch and wait" strategy is not considered the best option, a second-line treatment by a low to moderate dose (25–40 Gy) involved site radiation therapy (ISRT) in this usually localized disease may be proposed.

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