title: Infectious disease associations in advanced stage, indolent lymphoma (follicular and nonfollicular): developing a lymphoma prevention strategy.
abstract: BACKGROUND
  Eradication of Helicobacter pylori in gastric mucosa-associated lymphoid tumor can result in lymphoma remission. We prospectively identified/treated infections in nonbulky, advanced stage indolent lymphoma (follicular; nonfollicular lymphoma) eligible for observation.
  
  
  METHODS
  Stool H. pylori, hepatitis C and Borrelia serologies, Borrelia and Chlamydia fixed tissue PCR, Chlamydia peripheral blood mononuclear cell PCR and hydrogen breath test for small bowel bacterial overgrowth (SBBO) were obtained.
  
  
  RESULTS
  Fifty-six patients were enrolled. Positive infections: H. pylori (13); hepatitis C (3); SBBO (11). Negative: Borrelia (13); Chlamydophila psittaci (12, except one PCR). Lymphoma responses to antimicrobial therapy: H. pylori [one complete response (CR), 24+ months; one transient near CR]; hepatitis C [two CRs, 18+ and 30+ months; one partial response (PR) but hepatitis C virus persistent]; SBBO (one PR, 30+ months). Patients with associated infections, but without lymphoma CR, have required lymphoma treatment sooner than those without initial infections (treatment-free survival at 23.4 months median follow-up, 40.5% versus 74.7%, P = 0.01), indicating a different biology.
  
  
  CONCLUSIONS
  Infections are common in advanced stage indolent lymphoma (37.5% in our series). Anecdotal lymphoma responses have been seen and three have been durable CRs (18 to 30+ months) with infection eradication alone. The identification and treatment of associated infections may be a first step towards developing a lymphoma prevention strategy.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY 10021, USA. portlocc@mskcc.org
authors.forename: C S
authors.initials: CS
authors.lastname: Portlock
authors.forename: P
authors.initials: P
authors.lastname: Hamlin
authors.forename: A
authors.initials: A
authors.lastname: Noy
authors.forename: W
authors.initials: W
authors.lastname: Chey
authors.forename: C A
authors.initials: CA
authors.lastname: Gaydos
authors.forename: L
authors.initials: L
authors.lastname: Palomba
authors.forename: I
authors.initials: I
authors.lastname: Schwartz
authors.forename: S
authors.initials: S
authors.lastname: Corcoran
authors.forename: L
authors.initials: L
authors.lastname: Rosenzweig
authors.forename: D
authors.initials: D
authors.lastname: Walker
authors.forename: G
authors.initials: G
authors.lastname: Papanicolaou
authors.forename: A
authors.initials: A
authors.lastname: Markowitz
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000187:drug effects / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents