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Lymphoma

Early-Stage Gastric MALT Lymphoma: Is It a Truly Localized Disease?

^aDepartment of Haematology, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece; ^bDepartment of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece

Key Words. MALT lymphoma • Monoclonality • Occult disease • VH genes

Correspondence: Marina P. Siakantaris, M.D., 17, Ag. Thoma, Athens 11527, Greece. Telephone: 0030210-7771161; Fax: 0030210-7788830; e-mail: msiaka{at}med.uoa.gr

Received August 11, 2008; accepted for publication January 12, 2009; first published online in THE ONCOLOGIST Express on February 9, 2009.

Disclosure

Marina P. Siakantaris: None; Gerassimos A. Pangalis: None; Evangelia Dimitriadou: None; Flora N. Kontopidou: None; Theodoros P. Vassilakopoulos: None; Christina Kalpadakis: None; Sotirios Sachanas: None; Xanthi Yiakoumis: None; Penelope Korkolopoulou: None; Marie-Christine Kyrtsonis: None; Panayia Bobotsis: None; Athina Androulaki: None; Eustratios Patsouris: None; Panayiotis Panayiotidis: None; Maria K. Angelopoulou: None

Section editor George P. Canellos has disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in lymphoma oncology.

Early-stage gastric mucosa-associated lymphoid tissue lymphoma (GML) is considered a localized disease with an indolent course. Circulating malignant cells have been detected in other early-stage indolent lymphomas by molecular methods. We investigated the incidence of occult blood disease in early-stage GML patients, its impact on clinical outcome, and the similarity between blood and gastric lymphocytic clones. Sixty-two patients with localized GML were included in the study; 51 of them had Helicobacter pylori infection. Monoclonality was investigated by leader polymerase chain reaction. Sequencing was performed for the immunoglobulin variable gene (VH) analysis. Blood involvement was absent in all patients by conventional staging methods. In the whole group of 62 patients, the incidence of blood IgH rearrangement was 45%, and this did not correlate with baseline patient characteristics. The monoclonal blood and gastric products of five patients were sequenced and compared with each other. Clonal identity was evident in four of five patients. The VH3 gene was the most frequently used, both in the blood and in the stomach. Early-stage GML is not a truly localized disease because half the patients had a circulating clone, probably identical to the gastric one. The clinical significance of occult blood disease and the potential appropriate intervention need to be further investigated.