De-escalating therapy in gastric aggressive lymphoma

Area of Science:

• Oncology
• Gastroenterology
• Hematology

Background:

• Primary gastric diffuse large B-cell lymphoma (DLBCL) treatment has shifted from surgery to conservative therapies.
• Evidence suggests avoiding consolidation radiotherapy for limited-stage gastric DLBCL after rituximab-CHOP if complete remission is achieved.

Purpose of the Study:

• To evaluate the efficacy of conservative treatments for primary gastric DLBCL.
• To identify patient subgroups potentially curable with H. pylori eradication alone.

Main Methods:

• Review of recent prospective trials and low-level evidence.
• Analysis of treatment outcomes for limited-stage H. pylori-positive gastric DLBCL with favorable prognostic factors.

Main Results:

• Selected patients with limited-stage H. pylori-positive gastric DLBCL and favorable factors achieved excellent disease control and cure rates with antibiotics alone.
• Chemo-radiotherapy was reserved for non-responsive patients.
• This approach is applicable to mucosa-associated lymphoid tissue-related and de novo DLBCL.

Conclusions:

• Antibiotic therapy for H. pylori eradication is a viable option for selected patients with limited-stage gastric DLBCL.
• Future research should identify reliable predictors for selecting patients for H. pylori eradication alone versus conventional chemo-immunotherapy.