title: Bacteria-eradicating therapy with doxycycline in ocular adnexal MALT lymphoma: a multicenter prospective trial.
abstract: BACKGROUND
  An association between ocular adnexal MALT lymphoma (OAL) and Chlamydia psittaci (Cp) infection has been proposed, and recent reports suggest that doxycycline treatment causes tumor regression in patients with Cp-related OAL. The effectiveness of doxycycline treatment in Cp-negative OAL has not been tested.
  
  
  METHODS
  In a prospective trial, 27 OAL patients (15 newly diagnosed and 12 having experienced relapse) were given a 3-week course of doxycycline therapy. Objective lymphoma response was assessed by computerized tomography scans or magnetic resonance imaging at 1, 3, and 6 months after the conclusion of therapy and every 6 months during follow-up. Cp infection in patients was determined by touchdown enzyme time-release polymerase chain reaction (TETR-PCR). Statistical tests were two-sided.
  
  
  RESULTS
  Eleven patients were Cp DNA-positive and 16 were Cp DNA negative. Doxycycline was well tolerated. At a median follow-up of 14 months, lymphoma regression was complete in six patients, and a partial response (> or = 50% reduction of all measurable lesions) was observed in seven patients (overall response rate [complete and partial responses] = 48%). Lymphoma regression was observed in both Cp DNA-positive patients (seven of 11 experienced regression) and Cp DNA-negative patients (six of 16 experienced regression) (64% versus 38%; P = .25, Fisher's exact test). The three patients with regional lymphadenopathies and three of the five patients with bilateral disease achieved objective response. In relapsed patients, response was observed both in previously irradiated and nonirradiated patients. The 2-year failure-free survival rate among the doxycycline-treated patients was 66% (95% confidence interval = 54 to 78), and 20 of the 27 patients were progression free.
  
  
  CONCLUSIONS
  Doxycycline is a fast, safe, and active therapy for Cp DNA-positive OAL that was effective even in patients with multiple failures involving previously irradiated areas or regional lymphadenopathies. The responses observed in PCR-negative OAL may suggest a need for development of more sensitive methods for Cp detection and investigation of the potential role of other doxycycline-sensitive bacteria.
authors.affiliation: Medical Oncology Unit, Department of Oncology, San Raffaele H Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. andres.ferreri@hsr.it
authors.forename: Andrés J M
authors.initials: AJ
authors.lastname: Ferreri
authors.forename: Maurilio
authors.initials: M
authors.lastname: Ponzoni
authors.forename: Massimo
authors.initials: M
authors.lastname: Guidoboni
authors.forename: Antonio Giordano
authors.initials: AG
authors.lastname: Resti
authors.forename: Letterio S
authors.initials: LS
authors.lastname: Politi
authors.forename: Sergio
authors.initials: S
authors.lastname: Cortelazzo
authors.forename: Judit
authors.initials: J
authors.lastname: Demeter
authors.forename: Francesco
authors.initials: F
authors.lastname: Zallio
authors.forename: Angelo
authors.initials: A
authors.lastname: Palmas
authors.forename: Giuliana
authors.initials: G
authors.lastname: Muti
authors.forename: Giuseppina P
authors.initials: GP
authors.lastname: Dognini
authors.forename: Elisa
authors.initials: E
authors.lastname: Pasini
authors.forename: Antonia Anna
authors.initials: AA
authors.lastname: Lettini
authors.forename: Federico
authors.initials: F
authors.lastname: Sacchetti
authors.forename: Carlo
authors.initials: C
authors.lastname: De Conciliis
authors.forename: Claudio
authors.initials: C
authors.lastname: Doglioni
authors.forename: Riccardo
authors.initials: R
authors.lastname: Dolcetti
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002691:Chlamydophila psittaci / Q000187:drug effects* / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000302:isolation & purification; D018572:Disease-Free Survival; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009918:Orbital Neoplasms / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D009956:Psittacosis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D004269:DNA, Bacterial; D004318:Doxycycline