Instituts für 1 Pathologie, 2 Immunbiologie, 3 Medizinische Poliklinik, Universität Würzburg, Würzburg; 4 Innere Medizin, Klinikum Aschaffenburg, Aschaffenburg, Germany
*E-mail: matth.eck@gmx.de
The significance of underlying autoimmune diseases in gastric MALT-type lymphoma is a matter of debate. Recently, Raderer et al. [1] reported an impaired response of gastric low-grade MALT-type lymphoma to Helicobacter pylori eradication in a small collective of patients suffering from autoimmune diseases.
Stimulated by this study we tested in patients with low- and high-grade gastric MALT-type lymphoma a panel of five serum autoantibodies (ANA, antinuclear antibodies; ENA, exctractable nuclear antigens; PCA, parietal cell antibodies; TGA, thyroglobulin antibodies; TPO, thyroid peroxidase antibodies), which are often used as screening markers for local and systemic autoimmune diseases. The autoimmune phenotype of these lymphoma patients was compared with patients suffering from H. pylori gastritis, the background of which MALT-type lymphoma arises, and with patients suffering from autoimmune gastritis, the prototype of an autoimmune disease. ANAs were tested by an immunofluorescence test (Viramed; Planegg, Germany), ENAs, PCAs, TGAs and TPOs by ELISA-Kits (Pharmacia, Freiburg, Germany).
Only 21.5% of the patients with MALT-type lymphoma (n = 65; 11 patients with one positive autoantibody, two patients with two positive autoantibodies and one patient with three positive autoantibodies) and 26.7% of the patients with H. pylori gastritis (n = 30; three patients with one positive autoantibody, four patients with two positive autoantibodies and one patient with three positive autoantibodies) were positive for autoantibodies. In contrast, 100% of the patients with autoimmune gastritis (n = 23; 14 patients with one positive autoantibody, five patients with two positive autoantibodies, three patients with three positive autoantibodies and one patient with five positive autoantibodies) displayed positivity for one or more autoimmune markers. In 19 of the 34 patients with low-grade MALT-type lymphoma a H. pylori eradication therapy has been performed. In this subgroup, patients with complete tumor remission after H. pylori eradication did not differ with respect to the investigated autoantibodies from patients who did not respond to an eradication therapy (Table 1).
|
Our results show no association between gastric MALT-type lymphoma and autoimmune diseases. In contrast to Raderer et al., there was no evidence that an underlying autoimmune disease may be the reason for an unsuccessful eradication therapy of low-grade gastric MALT-type lymphoma [1].
Recently, genetic factors such as t(11;18) (q21;q21) translocation or bcl10 nuclear expression have been proposed to be suitable markers for patients with gastric MALT-type lymphomas that will not respond to a H. pylori eradication therapy [2].
Therefore, no patients with gastric MALT-type lymphoma should be excluded from a potential curative eradication therapy because of a co-existing autoimmune disease.
M. Eck1* B. Schmausser1 T. Kerkau2 A. Greiner1 M. Kraus3 W. Fischbach4 H. K. Müller-Hermelink
Instituts für 1Pathologie, 2Immunbiologie, 3Medizinische Poliklinik, Universität Würzburg, Würzburg; 4Innere Medizin, Klinikum Aschaffenburg, Aschaffenburg, Germany (*E-mail: matth.eck@gmx.de)
References
1. Raderer M, Oesterreicher C, Machold K et al. Impaired response of gastric MALT-lymphoma to Helicobacter pylori eradication in patients with autoimmune disease. Ann Oncol 2001; 12: 937939.[Abstract]
2. Liu H, Ye H, Ruskone-Fourmestraux A et al. t(11;18) is a marker for all stage gastric MALT lymphomas that will not respond to H. pylori eradication. Gastroenterology 2002; 122: 12861294.[ISI][Medline]