胃と腸42巻8号

2007年07月発行

今月の主題 胃MALTリンパ腫―除菌無効例の特徴と治療戦略 主題症例

除菌後に長期間完全寛解しているびまん性大細胞型B細胞リンパ腫の3例―胃高悪性度リンパ腫に対する除菌治療

著者： 加藤俊幸¹ 船越和博¹ 孫暁梅¹ 佐々木俊哉¹ 秋山修宏¹ 本山展隆¹ 星隆洋¹

所属機関： ¹新潟県立がんセンター新潟病院内科

ページ範囲：P.1277 - P.1282

要旨　胃MALTリンパ腫に対する除菌効果は，既に明らかであるが，高悪性度化した混合型やDLBCLではH. pylori感染よりも遺伝子変異への依存度が大きくなり除菌効果は基本的に無効とされている．しかし，出血や穿孔を除き高悪性度リンパ腫でも非手術的な放射線化学療法や抗体化学療法が選択され，高悪性度のDLBCLでも除菌治療の奏効例が散見されるようになった．今回，患者希望により胃限局期のH. pylori陽性DLBCLに対して除菌治療を試みた結果，6例中3例（50％）で腫瘍が消失し48～92週の長期間にわたる完全寛解を認めている．高悪性度リンパ腫に対する除菌治療の報告はまだ少ないが，H. pylori陽性例の特に高齢者における非手術的治療の選択肢の1つとして試みる価値はあると考えられ，その有効性を確認する大規模な前向き研究が望まれる．

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