Few studies have been conducted in relation to gastric MALT lymphoma-associated strains. Koehler et al. reported that the vacAm2 allele predominated in MALT lymphoma-associated isolates [17]. In previous studies [18,19] including an identical collection of H. pylori gastric MALT lymphoma strains to that used here, the authors confirmed this finding and suggested that certain combinations of genomic markers may have a predictive value for determining whether gastric MALT lymphoma develops. All these data suggest the potential role for bacterial determinism in the clinical outcome of MALT lymphoma.