除菌無効胃MALTリンパ腫の治療法の選択とその時期

Treatment for Gastric MALT Lymphoma Unresponsive to H. pylori Eradication

要旨　胃MALTリンパ腫のH. pylori除菌療法が無効の場合，まずAPI2-MALT1遺伝子の有無を確認する．本遺伝子陽性の場合は早急に治療する必要はなく，場合によっては経過観察もありうるが，一般的には放射線療法，化学療法，手術療法のいずれかを行う．一方API2-MALT1遺伝子陰性の場合は，治療後慎重に経過観察し，不変あるいは増大傾向がみられれば迅速に放射線療法，化学療法，手術療法のいずれか，場合によってコンビネーション治療を行う．特に本遺伝子陰性例の中には，除菌療法終了後急速に悪化する例がみられるので，治療直後は厳重な経過観察が必要である．全体として最近特に放射線療法で手術療法と変わらない良好な成績が得られており期待がもたれている．

　When gastric MALT lymphoma is unresponsive to eradication treatment for H. pylori, the presence or absence of API2-MALT1 fusion transcript should be examined. If the fusion transcript is present, then careful observation may be one of the treatment options, but generally monotherapy with surgical operation, radiation or chemotherapy can be considered. On the other hand, in cases without the fusion transcript, following short term careful observation, monotherapy with surgical operation, radiation, chemotherapy, or sometimes combination therapy should be promptly performed. Moreover, it should be noted that there are some cases, in which MALT lymphoma aggravates very rapidly immediately after eradication. Intensive observation is required for such cases.

　1) Department of Gastroenterology and Hepatology, Kyoto University, Kyoto, Japan