Gastric mucosa-associated lymphoid tissue lymphoma detected by clonotypic polymerase chain reaction despite continuous pathologic remission induced by involved-field radiotherapy Journal Article


Authors: Noy, A.; Yahalom, J.; Zaretsky, L.; Brett, I.; Zelenetz, A. D.
Article Title: Gastric mucosa-associated lymphoid tissue lymphoma detected by clonotypic polymerase chain reaction despite continuous pathologic remission induced by involved-field radiotherapy
Abstract: Purpose: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is indolent and often associated with Helicobacter pylori bacterial infection. H pylori-independent MALT develops either in the absence of the bacteria or persists after bacterial eradication. We have previously demonstrated long-term pathologic remission after involved-field radiotherapy therapy (IFRT). We determined molecular remission status by clonotypic polymerase chain reaction (PCR). Patients and Methods: Twenty-four consecutive patients with stage I to IIE gastric MALT lymphoma who obtained a pathologic remission after IFRT alone were evaluated. All had at least two follow-up endoscopic gastroduodenal biopsies at Memorial Sloan-Kettering Cancer Center. IFRT median dose was 30 Gy (range, 28.5 to 43.5 Gy). Post-treatment biopsies were subjected to semi-nested clonotypic PCR. Results: All patients obtained a complete response based on routine immunohistochemical pathologic analysis of random post-treatment gastric biopsies. Median follow-up from completion of IFRT was 63 months (range, 19 to 117 months). Event-free survival was 96%; 23 of 34 patients remained in clinical and pathologic complete remission. Baseline DNA extraction yielded 17 clone-specific primer pairs. At the first follow-up test, 14 of 17 pairs were PCR positive. Eight remained persistently positive; and one was persistently negative. Others were intermittently positive. Conclusion: Despite sustained biopsy-proven remissions for as long as 117 months after radiation, the vast majority of patients remain positive by clonotypic PCR. This suggests that the malignant clone is present but missing either an internal or external signal essential to the cancer phenotype. One possibility is that radiation eradicates the polyclonal H pylori-specific T cells eliminating critical local factors necessary for proliferation of the monoclonal B cells. © 2005 by American Society of Clinical Oncology.
Keywords: immunohistochemistry; clinical article; controlled study; human tissue; treatment response; genetics; cancer radiotherapy; radiation dose; cancer staging; follow up; polymerase chain reaction; metabolism; radiotherapy dosage; dna; immunoglobulin heavy chain; immunoglobulin heavy chains; dna, neoplasm; remission; remission induction; cell clone; clone cells; gastrointestinal endoscopy; helicobacter infection; mucosa associated lymphoid tissue lymphoma; stomach biopsy; lymphoma, mucosa-associated lymphoid tissue
Journal Title: Journal of Clinical Oncology
Volume: 23
Issue: 16
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2005-06-01
Start Page: 3768
End Page: 3772
Language: English
DOI: 10.1200/jco.2005.10.018
PUBMED: 15923573
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 10" - "Export Date: 24 October 2012" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Joachim Yahalom
    394 Yahalom
  2. Ariela Noy
    204 Noy
  3. Andrew D Zelenetz
    546 Zelenetz
  4. Ian Brett
    2 Brett