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• W2912429781 abstract "MALT lymphoma is the most common primary lymphoma of the GI tract. Though gastric MALT lymphoma is well described, only 17 cases of primary duodenal MALT lymphoma are reported. The use of rituximab has never been reported. A 64 year old man with hypertension had three years of intermittent GI bleeding. Multiple endoscopies showed duodenitis with ulceration. Biopsies of the stomach and duodenum on five occasions showed peptic duodenitis without H. pylori. Work-up for Zollinger-Ellison syndrome was negative and all NSAIDs were discontinued without improvement. Despite a highly selective vagotomy, the duodenitis and ulcerations persisted, prompting referral. On presentation, the patient was taking esomeprazole twice daily and ranitidine nightly. Four weeks after an empiric course of H. pylori therapy, endoscopy showed duodenal erosions with biopsies revealing duodenitis. Sucralfate was started and endoscopy three months later showed duodenitis with an eosinophilic infiltrate. Cromolyn was prescribed and endoscopy four months later was unchanged. However, biopsies revealed a dense CD20-positive lymphocyte infiltrate. MALT lymphoma was confirmed by flow cytometry. PET scan showed increased radiotracer uptake in the duodenum with no metastases. The patient did not want extensive chemotherapy, radiation therapy, or surgery; therefore, a one month course of rituximab was given. A follow-up PET scan showed persistent, though notably less, uptake in the duodenum. An endoscopy revealed persistent MALT lymphoma. In the setting of only a partial response to rituximab, the patient underwent radiation therapy. Of the reported cases of primary duodenal MALT lymphoma, only three patients responded solely to H. pylori eradication. All other cases were treated with either chemotherapy or surgery. Different chemotherapeutic regimens include oral cyclophosphamide; CHOP followed by vinblastine/etoposide/epirubicin/prednisone; CVP; and clarithromycin monotherapy. In the remainder of cases, surgery was the preferred. We avoided more toxic regimens for rituximab, a chimeric monoclonal antibody to CD20-positive lymphocytes. Rituximab has demonstrated efficacy in a variety of lymphomas and with response rates as high as 64% in gastric MALT lymphoma. There are no reports of its use in primary duodenal MALT lymphoma. Given rituximab's ease of administration and reasonable side effect profile, it may be a viable alternative for treatment in the absence of response to H. pylori eradication." @default.
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• W2912429781 date "2007-09-01" @default.
• W2912429781 modified "2023-10-18" @default.
• W2912429781 title "Primary Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Rituximab" @default.
• W2912429781 doi "https://doi.org/10.14309/00000434-200709002-00674" @default.
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