title: A Positive Prospective Trial of Antibiotic Therapy in Advanced Stage, Non-Bulky Indolent Lymphoma.
abstract: BACKGROUND
  We have prospectively studied a three month course of clarithromycin (substituted by Prevpac®, lansoprazole/ amoxicillin/ clarithromycin, in the first two wks when stool H pylori+) for non-bulky, advanced stage indolent lymphoma. These patients are often candidates for expectant monitoring and it is during this period that a window of opportunity may exist to identify and treat associated infections.
  
  
  METHODS
  All previously untreated patients with a new diagnosis of indolent lymphoma (FL and non-FL) meeting GELF criteria were treated with 12 weeks of clarithromycin. There were 32 evaluable patients, 4 of whom had stool H pylori.
  
  
  RESULTS
  At one month post-antibiotic therapy, we have observed lymphoma responses in 7 of 32 patients (21.9%). Two additional patients had objective response during followup (28.1% overall response). The median treatment free survival for antibiotic responders is 69.9 months and for non-responders, 30.6 months (p = 0.019).
  
  
  CONCLUSIONS
  Three response patterns have been noted, perhaps suggestive of an immune-mediated response -- prompt PET negative; flair with delayed PET negative response; and gradual continuous improvement. This prospective study appears promising, may be a step toward developing a lymphoma prevention strategy by reducing "antigen drive," and deserves further clinical/biological study. http://clinicaltrials.gov/show/NCT00461084.
authors.affiliation: Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Carol S
authors.initials: CS
authors.lastname: Portlock
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hamlin
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Gerecitano
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Maria Lia
authors.initials: ML
authors.lastname: Palomba
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Janelle
authors.initials: J
authors.lastname: Walkley
authors.affiliation: Memorial Sloan Kettering Cancer Center, Office of Physician-in-Chief, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Stacie
authors.initials: S
authors.lastname: Corcoran
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Migliacci
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Heiko
authors.initials: H
authors.lastname: Schoder
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Genovefa
authors.initials: G
authors.lastname: Papanicolaou
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA.
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Markowitz
keywords: Clarithromycin; antibiotic; free survival; improvement; indolent lymphoma; treatment