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ABSTRACT: In der Entstehung des Magenlymphoms vom MALT-Typ („Mucosa-Associated Lymphoid Tissue“) spielt die Helicobacter- (H.-)pylori-Infektion die zentrale Rolle. Sie führt zum Einwandern der B-Lymphozyten in die Magenschleimhaut und stimuliert zusammen
mit Antigenen bzw. Autoantigenen die Proliferation der B-Lymphozyten, die letztlich den Boden für die neoplastische Transformation
darstellt. Das histologische Bild des MALT-Lymphoms weist eine ausgeprägte Ähnlichkeit zum Aufbau des physiologischen MALT
auf. Wichtigstes diagnostisches Kriterium ist dabei die Invasion des Magenepithels mit Ausbildung so genannter lymphoepithelialer
Läsionen. Zytologisch zeigt das MALT-Lymphom meistens ein zentrozytoides oder monozytoides Erscheinungsbild. Immunhistochemische
Untersuchungen sind hilfreich zur definitiven Lymphomdiagnose und zur Abgrenzung von anderen kleinzelligen Lymphomen im Magen.
Der Phänotyp des MALT-Lymphoms ist identisch zu den nichtneoplastischen B-Zellen der Marginalzone (CD20+, CD5–, CD10–, CD23–).
Die Therapie erfolgt individualisiert in Abhängigkeit von histologischem Typ und Stadium. Das Therapieziel besteht heute in
der Heilung des Lymphoms und kann durch eine H.-pylori-Eradikation, Strahlentherapie, Chemotherapie, Operation oder durch deren Kombination erreicht werden.
Helicobacter pylori infection plays a central role in the development of gastric MALT-type (mucosa-associated lymphoid tissue)
lymphoma. Infection results in chronic H. pylori gastritis and stimulates together with antigens or autoantigens proliferation
of B-lymphocytes which is the basis for the neoplastic transformation. Histology of MALT-type lymphoma is architecturally
similar to the physiological MALT. Invasion and destruction of the gastric epithelium with development of so-called lympho-epithelial
lesions is the most important diagnostic criterion. Cytologically MALT-lymphoma resembles centrocytes and monocytes. For definitive
lymphoma diagnosis and for the differential diagnosis from other small cell lymphomas in the stomach immunohistochemistry
can be helpful. The phenotype of MALT-type lymphoma is identical to non-neoplastic B-lymphocytes of the marginal zone (CD20+,
CD5-, CD10- and CD23-). Individual therapy is strongly dependent from histological type and lymphoma stadium. Therapy modalities
are H. pylori eradication, radiochemotherapy, surgery or a combination of these. Aim of the therapy is the complete lymphoma
regression and cure of the disease.
SchlüsselwörterMALT-Lymphom-
Helicobacter pylori
-Marginalzonen B-Zell-Lymphom-Magenlymphom
KeywordsMALT-lymphoma-Helicobacter pylori-Marginal zone B-cell lymphoma-Gastric lymphoma
Der Pathologe 04/2012; 31(3):188-194. · 0.67 Impact Factor
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J M Löhr,
S L Haas,
W-O Bechstein,
G Bodoky,
K Cwiertka, W Fischbach,
U R Fölsch,
D Jäger,
D Osinsky,
J Prausova,
W E Schmidt,
M P Lutz
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ABSTRACT: Paclitaxel embedded in cationic liposomes (EndoTAG™-1; ET) is an innovative agent targeting tumor endothelial cells. This randomized controlled phase II trial evaluated the safety and efficacy of ET in combination with gemcitabine (GEM) in advanced pancreatic cancer (PDAC).
Chemotherapy-naive patients with locally advanced or metastatic disease were randomly assigned to receive weekly GEM 1000 mg/m(2) or GEM plus twice-weekly ET 11, 22 or 44 mg/m(2) for 7 weeks. After a safety run-in of 100 patients, a second cohort continued treatment. End points included overall survival (OS), progression-free survival (PFS), tumor response and safety.
Two hundred and twelve patients were randomly allocated to the study and 200 were treated (80% metastatic, 20% locally advanced). Adverse events were manageable and reversible. Transient thrombocytopenia and infusion reactions with chills and pyrexia mostly grade 1 or 2 occurred in the ET groups. Disease control rate after the first treatment cycle was 43% with GEM and 60%, 65% and 52% in the GEM + ET cohorts. Median PFS reached 2.7 compared with 4.1, 4.6 and 4.4 months, respectively. Median OS was 6.8 compared with 8.1, 8.7 and 9.3 months, respectively.
Treatment of advanced PDAC with GEM + ET was generally well tolerated. GEM + ET showed beneficial survival and efficacy. A randomized phase III trial should confirm this positive trend.
Annals of Oncology 09/2011; 23(5):1214-22. · 6.43 Impact Factor
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M Moehler,
S-E Al-Batran,
T Andus,
M Anthuber,
J Arends,
D Arnold,
D Aust,
P Baier,
G Baretton,
J Bernhardt, [......],
P Thuss-Patience,
K Treml,
U Vanhoefer,
M Vieth,
H Vogelsang,
D Wagner,
U Wedding,
A Weimann,
H Wilke,
C Wittekind
Zeitschrift für Gastroenterologie 04/2011; 49(4):461-531. · 0.90 Impact Factor
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ABSTRACT: This consensus report of the EGILS (European Gastro-Intestinal Lymphoma Study) group includes recommendations on the management of gastric extranodal marginal zone B-cell lymphoma of MALT. They are based on data from the literature and on intensive discussions and votings of the experts during their annual meetings.
Gut 02/2011; 60(6):747-58. · 10.11 Impact Factor
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Zeitschrift für Gastroenterologie 04/2010; 48(4):E1. · 0.90 Impact Factor
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ABSTRACT: We report the case of a 74-year-old lady who presented at our clinic with icterus and cholestatic hepatitis. For atrial fibrillation she had been prescribed a medication with phenprocoumone. After ruling out viral, autoimmune, and metabolic causes of hepatitis, we performed a liver biopsy which led to the diagnosis of phenprocoumone-related liver damage. The patient was discharged without phenprocoumone and completely compensated liver function. Five weeks later she returned to the hospital with encephalopathy, ascites, coagulopathy, varices, and signs of cirrhosis in abdominal ultrasound. In spite of treatment with steroids, the patient died of subacute liver failure several weeks later. This case illustrates the occasionally poor course of toxic hepatitis even after discontinuation of the responsible medication, potential treatment options are discussed.
Zeitschrift für Gastroenterologie 03/2010; 48(3):398-400. · 0.90 Impact Factor
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ABSTRACT: Helicobacter pylori infection plays a central role in the development of gastric MALT-type (mucosa-associated lymphoid tissue) lymphoma. Infection results in chronic H. pylori gastritis and stimulates together with antigens or autoantigens proliferation of B-lymphocytes which is the basis for the neoplastic transformation. Histology of MALT-type lymphoma is architecturally similar to the physiological MALT. Invasion and destruction of the gastric epithelium with development of so-called lympho-epithelial lesions is the most important diagnostic criterion. Cytologically MALT-lymphoma resembles centrocytes and monocytes. For definitive lymphoma diagnosis and for the differential diagnosis from other small cell lymphomas in the stomach immunohistochemistry can be helpful. The phenotype of MALT-type lymphoma is identical to non-neoplastic B-lymphocytes of the marginal zone (CD20+, CD5-, CD10- and CD23-). Individual therapy is strongly dependent from histological type and lymphoma stadium. Therapy modalities are H. pylori eradication, radiochemotherapy, surgery or a combination of these. Aim of the therapy is the complete lymphoma regression and cure of the disease.
Der Pathologe 03/2010; 31(3):188-94. · 0.67 Impact Factor
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ABSTRACT: Type of lymphoma and stage of disease are the two decisive prognostic factors and therapeutic determinants. For the locoregional staging, i.e. assessment of the gastric wall infiltration and perigastric lymphonodular involvement, endoscopic ultrasound (EUS) is highly useful. EUS has, therefore, to be integrated into the standard staging procedure of gastric lymphoma, although its impact on initial treatment decisions might be limited in the individual case. A benefit from the use of miniechoendoscopes, EUS elastography and EUS-guided biopsies has not yet been proven in gastric lymphoma. EUS also confers an important prognostic value regarding treatment responses to Helicobacter pylori eradication. On the contrary, EUS cannot be recommended as a regular part of follow-up investigations considering its limited value in predicting the response of the lymphoma to radiation or chemotherapy.
Best practice & research. Clinical gastroenterology 02/2010; 24(1):13-7. · 2.48 Impact Factor
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W Fischbach
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ABSTRACT: The therapeutic strategy in gastric lymphoma has completely changed over the last two decades. This change is mainly characterised by the abandonment of surgery in favour of conservative therapies and the introduction of Helicobacter pylori eradication therapy. It became evident that conservative treatment with radiation and/or chemotherapy is at least as effective as surgical resection and additionally offers the advantage of stomach preservation and better quality of life. The therapeutic goal is undoubtedly complete remission of the lymphoma as a necessary basis for cure of the disease. Both radiotherapy and chemotherapy have a high curative potential in gastric MALT lymphoma and diffuse large B-cell lymphoma (DLBCL), respectively. An open question is the additional benefit of radiation following Rituximab-CHOP chemotherapy in DLBCL. In patients with gastric MALT lymphoma of stage I H. pylori eradication offers complete remission rates of up to 80% with excellent long-term prognosis and a real chance of cure. Patients with MALT lymphoma of stage II and those with DLBCL of stage I may also respond to eradication therapy in the individual case. It also emerged recently that there is no need for any oncological therapy in patients revealing minimal histological residuals after successful H. pylori eradication. A watch-and-wait strategy is the adequate management of this condition. In summary, therapy of gastric lymphoma is nowadays individualised with lymphoma type, stage, and H. pylori status as the determinants of the choice of treatment. Efficacy and quality of life are strong arguments for a definite conservative approach encompassing H. pylori eradication, radiation and chemotherapy.
Best practice & research. Clinical gastroenterology 02/2010; 24(1):71-7. · 2.48 Impact Factor
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W Fischbach,
P Malfertheiner,
J C Hoffmann,
W Bolten,
J Bornschein,
O Götze,
W Höhne,
M Kist,
S Koletzko,
J Labenz, [......],
U Peitz,
J Preiss,
C Prinz,
U Rosien,
W Schmidt,
A Schwarzer,
St Suerbaum,
A Timmer,
G Treiber,
M Vieth
[show abstract]
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ABSTRACT: This guideline updates a prior consensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Hygiene and Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE), and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based S 3 level consensus guideline and has also implemented grading criteria according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process. Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics, and therapy were taken into account.
Zeitschrift für Gastroenterologie 12/2009; 47(12):1230-63. · 0.90 Impact Factor
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W Fischbach
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ABSTRACT: Helicobacter pylori is associated with various gastroduodenal diseases such as peptic ulcer, functional dyspepsia, MALT lymphoma and distal gastric cancer. Diagnosis of H. pylori can be established by non-invasive ((13C)urea breath test, stool antigen test, serology) and invasive (histology, rapid urease test, culture) tests. In adults, culture and susceptibility testing should or must be performed after failing of first-line therapy in case of a control endoscopy and before third-line therapy, respectively. Peptic ulcer and gastric MALT lymphoma represent obligatory indications for eradication therapy. Other potential indications are functional dyspepsia, prevention of gastric cancer in individuals being at risk, and before starting treatment with traditional non-steroid antiphlogistics. First-line therapy is performed with a 7-days combination of proton pump inhibitor with clarithromycin and amoxicillin or metronidazole. In second-line therapy levofloxacin and rifabutin are good rescue antibiotics.
Der Internist 09/2009; 50(8):979-86; quiz 987. · 0.30 Impact Factor
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W Fischbach
MMW Fortschritte der Medizin 07/2009; 151(26-29):43-5.
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M P Ebert,
C Auernhammer,
K Caca,
F Eckel, W Fischbach,
M Geissler,
B Göke,
T Greten,
S Kubicka,
M P Lutz,
M Möhler,
O Opitz,
M Pavel,
R Porschen,
A Reinacher-Schick,
W Schmiegel,
T Seufferlein,
B Wiedenmann,
R M Schmid
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ABSTRACT: As a consequence of recent studies the treatment of gastrointestinal cancers has become challenging and is undergoing constant changes on the basis of the results of new trials. The steering committee of the working group on gastrointestinal cancers of the Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten has decided to summarise and present recent updates of the current treatment guidelines and recommendations for the most relevant gastrointestinal malignancies. In this review we have included recent findings from large trials on esophageal, gastric, pancreatic, cholangiocellular and liver cancers, as well as colorectal cancers, neuroendocrine tumours and lymphomas. This includes an update on the combination with novel targeted agents and the introduction of potential predictive biomarkers in the selection of the appropriate treatment strategy.
Zeitschrift für Gastroenterologie 04/2009; 47(3):296-306. · 0.90 Impact Factor
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W Fischbach,
P Malfertheiner,
J C Hoffmann,
W Bolten,
J Bornschein,
O Götze,
W Höhne,
M Kist,
S Koletzko,
J Labenz, [......],
U Peitz,
J C Preiss,
C Prinz,
U Rosien,
W E Schmidt,
A Schwarzer,
S Suerbaum,
A Timmer,
G Treiber,
M Vieth
[show abstract]
[hide abstract]
ABSTRACT: This guideline updates a prior concensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE) and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based consensus guideline of S 3 level and has also implemented grading criteria according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics and therapy were taken into account.
Zeitschrift für Gastroenterologie 02/2009; 47(1):68-102. · 0.90 Impact Factor
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ABSTRACT: The majority of gastrointestinal lymphomas belongs to the group of the MALT (mucosa-associated lymphoid type) lymphomas arising in the stomach, therefore rendering them accessible to endoscopy. Staging currently follows the modified Ann Arbor classification but most likely in the future, the TNM-based Paris staging system will be applied due to its detailed description of the local spread as well as the extraintestinal dissemination. For assessment of gut wall infiltration and local lymphonodular involvement, endoscopic ultrasound currently represents the standard procedure and is an essential diagnostic tool regarding locoregional staging. Additionally, the method confers a high prognostic value regarding treatment response in MALT lymphoma. In endoscopic ultrasound stage EI 1, Helicobacter pylori eradication leads in 70 - 100 % to a complete response. However, the value of endoscopic ultrasound in the follow-up of lymphomas after chemotherapy remains elusive and controversial. There is no clear correlation between histologically proven residual disease and endosonographic results. Thus, so far, endoscopic ultrasound will not replace bioptic surveillance after MALT lymphoma treatment.
Zeitschrift für Gastroenterologie 07/2008; 46(6):618-24. · 0.90 Impact Factor
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ABSTRACT: Eradication of Helicobacter pylori is the established initial treatment of stage I MALT (mucosa associated lymphoid tissue) lymphoma. Patients with minimal persisting lymphoma infiltrates after successful eradication of H pylori are considered treatment failures and referred for radiation, chemotherapy, immunotherapy, or surgery.
To report a watch and wait strategy in such patients.
108 patients were selected from a larger series of patients treated at various European institutions. Their mean age was 51.6 years (25 to 82), and they were all diagnosed as having gastric marginal zone B cell lymphoma of MALT type stage I. After successful H pylori eradication and normalisation of the endoscopic findings, lymphoma infiltrates were still present histologically at 12 months (minimal histological residuals). No oncological treatment was given but the patients had regular follow up with endoscopies and multiple biopsies.
Based on a follow up of 42.2 months (2-144), 102 patients (94%) had a favourable disease course. Of these, 35 (32%) went into complete remission. In 67 (62%) the minimal histological residuals remained stable and no changes became evident. Local lymphoma progression was seen in four patients (5%), and one patient developed a high grade lymphoma.
Most patients with minimal histological residuals of gastric MALT lymphoma after successful eradication of H pylori had a favourable disease course without oncological treatment. A watch and wait strategy with regular endoscopies and biopsies appears to be safe and may become the approach of choice in this situation. Longer follow up is needed to establish this definitively.
Gut 01/2008; 56(12):1685-7. · 10.11 Impact Factor
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ABSTRACT: Patients with gastric marginal zone-B-cell lymphoma of MALT-type of stage I are usually treated by eradication therapy as Helicobacter pylori infection is evident in the majority (> 90%) of them. In case of a negative Helicobacter pylori status, if the lymphoma does not reveal regression after successful eradication of the bacterium, or in stage II, radiation is nowadays the treatment of choice. Gastrectomy is only reserved for special conditions such as endoscopically not treatable bleeding or patient's explicit request. All treatment modalities follow a curative intention. We here report on a patient with a Helicobacter pylori negative MALT lymphoma of stage I presenting as a localized polypoid lesion in the gastric fundus. Radiotherapy was indicated. However, the patient refused this standard therapy as well as surgical resection as a possible alternative. When signs of lymphoma progression became evident we performed an endoscopy-assisted laparoscopic resection of the fundus which resulted in a continuing lymphoma-free condition. Thus, local treatment modalities such as endoscopic mucosal resection or laparoscopic resection may represent a therapeutic option in case of a localized lymphoma finding in the individual patient who is not suitable for or who refuse standard therapeutic approaches.
Zeitschrift für Gastroenterologie 05/2007; 45(5):383-6. · 0.90 Impact Factor
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ABSTRACT: Gastric lymphoma is most frequently an extranodal marginal zone-B-cell-lymphoma of mucosa-associated lymphoid tissue (MALT). The diagnosis is established by biopsy of the tumor. Computed-tomography, endosonography and recently capsule-endoscopy are used for staging. It is a relative new finding that MALT-lymphomas of the stomach are induced by Helicobacter pylori. A side-effect-poor breakthrough has been achieved by eradication of this bacterium with antibiotics. Refractory cases are amenable to radiotherapy, chemotherapy or surgical resection. The rarer aggressive lymphomas of the stomach are treated primarily by chemotherapy and radiotherapy. For both entities a further improvement may be achieved in ongoing prospective clinical trials by addition of the monoclonal antibody rituximab, which targets CD20 on lymphoma cells.
Praxis 09/2006; 95(31-32):1163-8.
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ABSTRACT: Limited financial resources in public health care have led to the introduction of clinical pathways as a means to a better effectivity and efficacy. Colorectal cancer met the requirements for establishing such a pathway in a distinguished way: high patient volume, high costs, interdisciplinary multi-modal treatment concepts in a relevant frequency, and existing evidence based guidelines. This article gives an example of a clinical pathway for colorectal cancer as established in our hospital. The potential of such pathways to save costs as well as their implications on treatment results and patients' satisfaction will have to be critically analyzed in the future before their value can be definitely estimated.
Der Internist 08/2006; 47(7):720-3, 725-8. · 0.30 Impact Factor
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ABSTRACT: Begrenzte finanzielle Ressourcen im Gesundheitswesen haben zur Einfhrung klinischer Ablaufpfade als Instrument fr eine Verbesserung der Effektivitt und Steigerung der Effizienz gefhrt. Das kolorektale Karzinom erfllte in besonderer Weise die Voraussetzungen fr die Etablierung eines Behandlungspfads in unserem Hause: hohes Patientenaufkommen, hohe Kosten, interdisziplinre multimodale Behandlungsanstze in relevanter Hufigkeit, bestehende evidenzbasierte Leitlinien. Dieser Beitrag stellt den fr unser Klinikum konzipierten Ablaufpfad exemplarisch vor. Das Einsparpotenzial solcher Behandlungspfade einerseits und ihre Auswirkungen auf Therapieergebnisse und Patientenzufriedenheit andererseits mssen zuknftig kritisch evaluiert werden, ehe sie einer endgltigen Beurteilung unterzogen werden knnen.Limited financial resources in public health care have led to the introduction of clinical pathways as a means to a better effectivity and efficacy. Colorectal cancer met the requirements for establishing such a pathway in a distinguished way: high patient volume, high costs, interdisciplinary multi-modal treatment concepts in a relevant frequency, and existing evidence based guidelines. This article gives an example of a clinical pathway for colorectal cancer as established in our hospital. The potential of such pathways to save costs as well as their implications on treatment results and patients satisfaction will have to be critically analyzed in the future before their value can be definitely estimated.
Der Internist 06/2006; 47(7):720-728. · 0.30 Impact Factor
