Bacteria-eradicating therapy with doxycycline in ocular adnexal MALT lymphoma: A multicenter prospective trial
Bacteria-eradicating therapy with doxycycline in ocular adnexal MALT lymphoma: A multicenter prospective trial
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DOI：
10.1093/jnci/djj373
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发表时间：
2006-10-04
影响因子：
10.3
通讯作者：
Dolcetti, Riccardo
中科院分区：
文献类型：
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作者：
Ferreri, Andres J. M.;Ponzoni, Maurilio;Dolcetti, Riccardo
背景。眼附件MALT淋巴瘤（OAL）与鹦鹉热衣原体（Cp）感染之间存在关联，最近的报道表明，强力霉素治疗可导致Cp相关OAL患者的肿瘤消退。强力霉素治疗cp阴性OAL的有效性尚未得到检验。方法：在一项前瞻性试验中，27例OAL患者（15例新诊断，12例复发）给予为期3周的强力霉素治疗。目的：在治疗结束后1、3、6个月及随访期间每6个月通过计算机断层扫描或磁共振成像评估淋巴瘤反应。采用触地酶缓释聚合酶链反应（tetrr - pcr）检测患者Cp感染情况。统计检验是双侧的。结果：Cp DNA阳性11例，Cp DNA阴性16例。多西环素耐受性良好。在中位随访14个月时，6例患者淋巴瘤完全消退，7例患者出现部分缓解（>=所有可测量病变减少50%）（总缓解率[完全和部分缓解]= 48%）。Cp dna阳性患者（11例中有7例出现淋巴瘤消退）和Cp dna阴性患者（16例中有6例出现淋巴瘤消退）均观察到淋巴瘤消退（64%对38%；P = 0.25， Fisher精确检验）。3例局部淋巴结病变患者和5例双侧病变患者中的3例均达到客观反应。在复发患者中，在先前放疗和未放疗的患者中均观察到应答。强力霉素治疗患者的2年无失败生存率为66%(95%可信区间= 54 ~ 78)，27例患者中有20例无进展。结论：强力霉素是一种快速、安全、有效的治疗Cp dna阳性OAL的方法，即使在涉及先前照射区域或局部淋巴结病的多次失败患者中也是有效的。在pcr阴性OAL中观察到的反应可能表明需要开发更敏感的Cp检测方法，并研究其他多西环素敏感细菌的潜在作用。
Background. An association between ocular adnexal MALT lymphoma (OAL) and Chlainydia 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 (>= 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.