About Lymphoma >  Antibiotics to treat lymphoma - indications

Last update: 01/10/2014

Antibiotic Therapy for MALT lymphoma

For MALT | Time to Response | When negative for H-Pylori?
For Ocular Adnexa MALT Lymphoma (OAML) | Clinical Trials

The premise that infection could contribute to the development and behavior of some lymphomas is based on the fact that lymphocytes (the cell of origin for lymphoma) are antigen-driven.  The normal function of these immune cells is to activate and replicate in response to infection. 

Thus it may be that in some cases a lymphoma (a defective lymphocyte) may still be activated and stimulated to progress by an existing infection.  The link is also supported by an observed association between chronic infection and some types of lymphoma.  See Bacterial infection as a cause of cancer

For some types of lymphoma, in particular MALT lymphoma, the infectious cause has been identified - and anti-bacterial therapy can lead to clinical remissions. 

Research findings suggest that antibiotic therapy for Helicobacter pylori infection may prolong remission in early gastric MALT lymphoma." Source: oncologychannel

Here we provide resources and reports on infection-associated lymphomas that may be responsive to antibiotic therapy.

Antibiotic Therapy for MALT Lymphomas

TOPIC SEARCH: Accuracy of H-pylori test: PubMed 

	Common Misconceptions in the Management of H-Pylori-associated Gastric MALT-lymphoma Management of H. Pylori-associated Gastric MALT-lymphoma: Antibiotic Treatment Has No Role in the Management of H. pylori-negative MALT Lymphoma http://bit.ly/1iqPvxS
	Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment  gut.bmjjournals.com full   "This study showed that 56% of localised low grade MALT GLs in H pylori positive patients achieved complete remission at 6-18 months after eradication of H pylori. In such patients, H pylori infection was accurately assessed by gastric histology and serology.  None of our H pylori negative GLs (23% of all cases) regressed. This makes systematic eradication of the bacteria, irrespective of H pylori status, of doubtful significance. In carefully selected H pylori positive patients without any lymph node involvement assessed by EUS (Gastric endoscopic ultrasonography), complete remission was achieved in 79% of cases. EUS proved more sensitive than endoscopy or CT scan for accurate staging, which was then crucial for predicting tumour response to bacterial eradication.  Lymph node involvement, even when paragastric, and/or tumour penetration beyond the submucosa, were indications of little or no response. The persistence of an abnormal B cell clone after H pylori eradication did not appear to affect the prognosis, but longer follow up studies are needed to confirm this.
	"MALT - Alimentary Pharmacology and Therapeutics: Common misconceptions in the management of H. pylori-associated gastric MALT
	MALT: The importance of monitoring for H. pylori re-infection  eurekalert.org "The significance of the described work is that gastric lymphoma progresses more rapidly upon secondary infection. Because resting B cells are left behind following antibiotic treatment, re-infection by H. pylori promotes the existing B cells to progress quickly into tumors.  Therefore, it is important that treated patients be carefully monitored for H. pylori re-infection."
	Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue. An uncontrolled trial. Ann Intern Med. 1999 Jul 20;131(2):88-95. PMID: 10419446  | Full text
	Antibiotic treatment for conjunctival MALT? H. pylori molecular signature in conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma. Histol Histopathol. 2004 Oct;19(4):1219-26. PMID: 15375765

What is the response rate to initial antibiotic treatment of gastric MALT, and time to response?

"Our results showed 82.8 % of remission induction in low grade gastric MALTOMA by H pylori eradication alone with a single relapse. 

About 50% of patients with low grade gastric MALTOMA showed complete remission by 4 months after H pylori eradication. 

However, delayed response by up to 33 months occurred in one case.

Overall, complete remission was achieved within 12 months in 85 percentile. 

We propose that it is necessary to wait for 12 months after initial eradication therapy of H pylori to define the time for H pylori eradication failure, because relapse is relatively rare after 12 months and nearby all the cases would have complete remission by 12 months. In addition, other treatment modalities could be used 12 months after initial H pylori eradication therapy, such as radiation therapy, surgery or chemotherapy. " - 

World J Gastroenterol  2004 January 15;10(2):223-226 Low grade gastric MALToma: Treatment strategies based on 10 year follow-up

Frontline Antibiotics when negative for H-Pylori?

A few patients have reported that antibiotics treatment has produced good results with MALT even when prior test indicated negative for H-Pylori infection. But we have not located any studies to support this practice, and case reports, lacking a denominator, should be interpreted with caution. 

TOPIC SEARCH: Accuracy of H-pylori test: PubMed 

	Case reports: Successful antibiotic treatment of H-pylori negative gastric MALT lymphomas  http://bit.ly/6rQCG2  All six patients had MALT lymphoma restricted to the stomach, and no evidence of infection with H pylori was found. Only one patient tested positive for t(11;18)(q21;q21) while the remaining five displayed no genetic aberrations. Following antibiotic treatment, endoscopic controls were performed every three months. Five patients responded with lymphoma regression between three and nine months following antibiotic treatment (one partial remission and four complete responses). One patient had stable disease for 12 months and was then referred for chemotherapy. Conclusions Patients with early stage gastric MALT lymphoma negative for H pylori might still benefit from antibiotic treatment as the sole treatment modality.
	Localized Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy Has Excellent Clinical Outcome. J Clin Oncol. 2003 Nov 15;21(22):4157-4164. PMID: 14615444 | full text
	MALT: The importance of monitoring for H. pylori re-infection  eurekalert.org "The significance of the described work is that gastric lymphoma progresses more rapidly upon secondary infection. Because resting B cells are left behind following antibiotic treatment, re-infection by H. pylori promotes the existing B cells to progress quickly into tumors.  Therefore, it is important that treated patients be carefully monitored for H. pylori re-infection."
	Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment  gut.bmjjournals.com full   "This study showed that 56% of localised low grade MALT GLs in H pylori positive patients achieved complete remission at 6-18 months after eradication of H pylori. In such patients, H pylori infection was accurately assessed by gastric histology and serology.  None of our H pylori negative GLs (23% of all cases) regressed. This makes systematic eradication of the bacteria, irrespective of H pylori status, of doubtful significance. In carefully selected H pylori positive patients without any lymph node involvement assessed by EUS (Gastric endoscopic ultrasonography), complete remission was achieved in 79% of cases. EUS proved more sensitive than endoscopy or CT scan for accurate staging, which was then crucial for predicting tumour response to bacterial eradication.  Lymph node involvement, even when paragastric, and/or tumour penetration beyond the submucosa, were indications of little or no response. The persistence of an abnormal B cell clone after H pylori eradication did not appear to affect the prognosis, but longer follow up studies are needed to confirm this."

Ocular (eye) Adnexa MALT Lymphoma (OAML)

Topic Search: PubMed

	Infect Agent Cancer. 2012: Chlamydia psittaci (CP) in ocular adnexa MALT lymphoma: a possible role in lymphomagenesis and a different geographical distribution ncbi.nlm.nih.gov "Ocular adnexa MALT-lymphomas represent approximatively 5-15% of all extranodal lymphomas. Almost 75% of OAMLs are localized in orbital fat, while 25% of cases involves conjunctive. The human psittacosis is generally caused by exposure to infected animals. Results following first line antibiotic treatment are variable [122]. Ferreri et al. documented an encouraging response following oral doxycycline for 3 weeks in 4 out of 9 patients with Cp positive OAML [12]. Abramson et al. showed a clinical response following antibiotic treatment in 3 patients with OAML [123], but Grunberger et al. did not obtain the same results. In another study 27 patients with OAML were treated with oral doxycycline [124]. Cp infection positive cases had an overall response rate of 64%, and also the Cp DNA negative cases showed a clinical response with a rate of 36%, indicating that doxycycline could be used in most OAML patients, independently of the diagnosis of Cp infection [30,64,117]. In a retrospective analysis of 38 patients with localized OAML, Kim et al. evaluated the effect of doxycycline for 3 weeks (12 patients) or 6 weeks (26 patients) [125]. After a median follow-up of 26.4 months, doxycycline resulted in an overall response rate of 47%. Patients treated with doxycycline for 6 weeks versus 3 weeks tended to have a higher response rate (54% vs 33%)."
	Trans Am Ophthalmol Soc. 2006: Detection of Helicobacter pylori and Chlamydia pneumoniae genes in primary orbital lymphoma. PubMed Chronic antigen stimulation is implicated as a causative agent in the development of some mature B-cell proliferations; for example, there are associations involving Helicobacter pylori with gastric or conjunctival MALT lymphoma and Chlamydia psittaci with ocular adnexal lymphoma. We examined the molecular signatures of H pylori and Chlamydia in eight orbital lymphomas.
	‘Blind’ antibiotic treatment targeting Chlamydia is not effective in patients with MALT lymphoma of the ocular adnexa annonc.oxfordjournals.org In this uncontrolled series, no effect of 'blind' antibiotic treatment with doxycyclin could be found in our patients with MALT lymphoma of the ocular adnexa. These results are in contrast to other series and suggest a potential geographic difference in the role of Chlamydia in ocular adnexal lymphoma. Thus, antibiotic therapy without prior testing for Chlamydia should be discouraged.