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Annals of Oncology Advance Access originally published online on October 26, 2007
Annals of Oncology 2008 19(2):254-258; doi:10.1093/annonc/mdm484
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© 2007 European Society for Medical Oncology. For Permissions, please email: journals.permissions@oxfordjournals.org

hematologic malignancies

Infectious disease associations in advanced stage, indolent lymphoma (follicular and nonfollicular): developing a lymphoma prevention strategy

C. S. Portlock1,*, P. Hamlin1, A. Noy1, W. Chey2, C. A. Gaydos3, L. Palomba1, I. Schwartz4, S. Corcoran1, L. Rosenzweig1, D. Walker1, G. Papanicolaou1 and A. Markowitz1

1 Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY
2 Department of Medicine, University of Michigan, Ann Arbor, MI
3 Department of Medicine, Johns Hopkins University, Baltimore, MD
4 Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, USA

* Correspondence to: Dr C. S. Portlock, Lymphoma Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room SR-425, NY 10021, USA. Tel: +1-212-639-8109; Fax: +1-646-422-2285; E-mail: portlocc{at}mskcc.org

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.

Materials and 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.

Conclusion: 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.

Key words: follicular lymphoma, indolent lymphoma, infections, prevention

Received for publication August 2, 2007. Revision received September 11, 2007. Accepted for publication September 13, 2007.


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