When H. pylori Triple Therapy Fails in Localized Gastric MALT Lymphoma: What Comes Next

This protocol is for patients with early-stage gastric MALT-type lymphoma in whom H. pylori infection was present and a first-line antibiotic-based regimen did not achieve its intended goals.

Clinical Scenario

Gastric MALT-type lymphoma, localized/early-stage disease, with H. pylori infection. The current situation follows an attempt at eradication therapy that did not produce complete remission.

Previous Line Did Not Achieve Its Goals

A first-line regimen of triple therapy — including levofloxacin, amoxicillin, and a PPI — was used with the aim of eradicating H. pylori infection and achieving complete remission of the gastric MALT lymphoma. When those targets are not met, this next-line protocol applies.

Next-Line Approach (Partial)

For persistent localized MALT lymphoma following antibiotic therapy, the approach involves radiation therapy directed to the involved field. The complete protocol — eligibility, sequencing, and full regimen details — is available via the link below.

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References

Until now, the most widely accepted initial treatment option for localized disease is the eradication of H pylori using the triple therapy based on the combination of proton-pomp inhibitors (PPI), clarithromycin with either amoxicillin or metronidazole for 10 to 14 days.
Several studies have confirmed the effectiveness of antibiotic therapy with long-term remissions in 70% to 100% of patients with localized, H pylori-positive, MALT lymphomas.
Therefore, "involved-field" irradiation (total dose of 30 Gy administered over 4 weeks) has continued to be the preferred treatment for patients with stage I and stage II MALT lymphomas without H pylori or with persistent lymphomas following antibiotic therapy.

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