AIM To report 3 of 120 patients on the German MALT lymphoma trial with H. pYlori-associated gastric MALT Iymphoma who developed early gastric cancer 4 and 5 years, after complete Iymphoma remission following cure of H. pylori infection.PATIENTS AND RESULTS Three patients (two men, 74 and 70 years; one women, 77 years)with H. pylori -associated low-grade MALTlymphoma achieved complete lymphoma remission after being cured. Surveillance endoscopies were performed twice a year in accordance to the protocol. Four years aftercomplete lymphoma remission in two patients,and after 5 years in the other, early gastric adenocarcinoma of the mucosa-type, type Ⅱ a and type Ⅱ c, respectively, was detetcted,which were completely removed by endoscopic mucosa resection. in one patient, the gastric cancer was diagnosed at the same location as the previous. MALT lymphoma, in the other patients it was detected at different sites of the stomach distant from location of the previous MALT lymphoma. The patients were H. pylori negative during the whole follow-up time.CONCLUSION These findings strengthen the importance of regular long-term follow-up endoscopies in patients with complete remission of gastric MALT lymphoma after cure of H.pylori infection. Furthermore, gastric adenocarcinoma may develop despite eradication of H. pylori.