04 October 2021

Researchers have developed a new imaging technique that could serve as an alternative to gastroscopies for the follow-up of gastric MALT lymphoma.

Mucosa-associated lymphoid tissue (MALT) lymphoma usually originates in the stomach and is closely linked to Helicobacter pylori infection. Most lymphoma subtypes can be assessed with positron emission tomography (PET) scan. However, owing to the poor binding of the radiotracer fluoro-D-glucose (FDG) to MALT lymphoma, FDG-PET cannot be used to assess the disease. Instead, the reference test for gastric MALT lymphoma is multiple biopsies, which are invasive and time-consuming.

Dr Marius Mayerhoefer and colleagues at MedUni Vienna set out to investigate the possibility of using PET scanning with an alternative radiotracer molecule. They used pentixafor which targets a receptor called CXCR4 which is often over-produced in MALT lymphoma. This approach could offer a non-invasive alternative to biopsy.

They tested this method to assess the response to H. pylori eradication treatment in 46 patients , 26 with gastric MALT lymphoma, and 20 without. Biopsies taken by esophagogastroduodenoscopy were carried out alongside as a comparison.

Pentixafor-PET scanning show a high success rate – 97% accuracy in detecting the tumour, compared with biopsy. Results were published in the journal Blood recently.

The authors write: “CXCR4 imaging with Pentixafor-PET may represent a promising test for assessment of residual gastric MALT lymphomas after H. pylori eradication.”

They add that the technique “has performed well for staging of different blood cancers including mantle cell and lymphoplasmacytic lymphoma and shown promise for treatment response assessment.”

Dr Mayerhofer said: “If a sufficiently high CXCR4 expression is detected at the initial diagnosis of MALT lymphoma, the new imaging could replace repeated gastroscopies in the course of the disease in the future or at least increase the time intervals between gastroscopies.”


Mayerhoefer M, Raderer M, Lamm W, Weber M, Kiesewetter B, Rohrbeck J, Simonitsch-Klupp I, Hacker M, Leisser A, Nics L, Schmitl S, Wester HJ, Haug A. (2021) “CXCR4 PET/MRI for follow-up of gastric mucosa-associated lymphoid tissue lymphoma after first-line H. pylori eradication.” Blood, doi: 10.1182/blood.2021013239

Link: https://ashpublications.org/blood/article/doi/10.1182/blood.2021013239/476918/CXCR4-PET-MRI-for-follow-up-of-gastric-mucosa

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