In this case series, two patients (one HP-positive and one HP-negative) underwent gastrectomy as first-line treatment while another two HP-positive patients underwent gastectomy for persistence of gastric EMZBL-MALT after Helicobacter eradication. These four patients were diagnosed to have disease in the era when surgery was still a prevalent treatment option for gastric lymphoma and all of them did

not suffer from relapse of lymphoma afterwards. Treatment outcome for those receiving Helicobacter eradication or single-agent chemotherapy as first-line treatment would be discussed in detail in the following paragraphs. Different treatment SIRT assay modalities and outcome were summarized in Figure 1. Figure 1 Treatment modalities Inhibitors,research,lifescience,medical and outcome Helicobacter eradication As first-line treatment for gastric EMZBL-MALT, PPI-based triple therapy was given to 20 subjects, whose gastric biopsies showed Helicobacter. For this group, median age Inhibitors,research,lifescience,medical was 71.5 years (IQR 54 to 81 years) and median follow-up time was 7.7 years (IQR 3.7 to 9 years). Disease remission happened within 6 months in fifteen subjects and within 15 months in another two subjects. Therefore, totally, Helicobacter eradication induced disease remission in seventeen Helicobacter-positive patients (85%).

No relapse of disease was observed in these responders. Three subjects, with successful Helicobacter eradication, Inhibitors,research,lifescience,medical did not have endoscopic or histological improvement all along. They were referred out and finally, free from disease after either gastrectomy or combination Inhibitors,research,lifescience,medical chemotherapy. Single-agent chemotherapy Seven Helicobacter-free subjects received single-agent chemotherapy as first-line treatment. Cyclophosphamide was the choice in all cases. At time of diagnosis, median age was 72

years (IQR 67 to 85 years) and median follow-up time was 4 years (IQR 3.1 to 7 years). Disease remission was observed in five Inhibitors,research,lifescience,medical subjects (71%) while response could not be evaluated in one subject, who defaulted follow-up around 6 weeks after starting cyclophosphamide. One of the responders had local relapse 27 months after stopping cyclophosphamide. This subject was diagnosed to have hepatocellular carcinoma (HCC) in the same period and opted not for treatment for both diseases in view of advanced age (89 years old). One subject, who had stage I disease initially, did not show any response to cyclophosphamide. She was subsequently however referred to oncology centre for combination chemotherapy (CHOP regime) because of progressive tumour growth. She eventually died 46 months after initial diagnosis due to disease progression (stage IV disease before death). Overall survival In this case series, eight patients passed away during the study period (mortality rate 27%) but only one of them died apparently from progression of gastric EMZBL-MALT as mentioned above.