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Annals of Oncology Advance Access published online on October 26, 2007
Annals of Oncology, doi:10.1093/annonc/mdm484
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© 2007 European Society for Medical Oncology

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: 56 patients 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.

follicular lymphoma, indolent lymphoma, infections, prevention

Received for publication August 2, 2007. Revision received September 11, 2007. Revision received September 12, 2007. Accepted for publication September 13, 2007.


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