Originally published as JCO Early Release 10.1200/JCO.2005.07.083 on June 20 2005

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Regression of Ocular Adnexal Lymphoma After Chlamydia Psittaci–Eradicating Antibiotic Therapy

From the Departments of Radiochemotherapy, Pathology, Ophthalmology, and Hematology, San Raffaele H Scientific Institute, Milan; Immunovirology and Biotherapy Unit, and Division of Experimental Oncology 1, Department of Pre-Clinical and Epidemiological Research, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico National Cancer Institute, Aviano, Italy; and First Department of Medicine, Semmelweis University, Budapest, Hungary

Address reprint requests to Andrés J.M. Ferreri, MD, Department of Radiochemotherapy, San Raffaele H Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; e-mail: andres.ferreri{at}hsr.it

PURPOSE: Some infectious agents contributing to lymphomagenesis have been considered targets for new therapeutic strategies. Chlamydia psittaci DNA has been detected in 80% of ocular adnexal lymphomas. The present pilot study was carried out to assess whether C psittaci–eradicating antibiotic therapy is associated with tumor regression in ocular adnexal lymphomas.

PATIENTS AND METHODS: Nine patients with C psittaci–positive marginal-zone B-cell lymphoma of the ocular adnexa at diagnosis or relapse were treated with doxycycline 100 mg, bid orally, for 3 weeks. The presence of C psittaci DNA in peripheral-blood mononuclear cells (PBMCs) was also assessed before and after treatment in seven patients. Objective lymphoma regression was assessed 1, 3, and 6 months after therapy conclusion and every 6 months during follow-up.

RESULTS: All patients completed antibiotic therapy with excellent tolerability. At 1 month from doxycycline assumption, chlamydial DNA was no longer detectable in PBMCs of all four positive patients. Objective response was complete in two patients, partial response (> 50%) was observed in two patients, and minimal response (< 50%) was observed in three patients. Duration of response in the seven responders was 12+, 29+, 31+, 8+, 7+, 2+, and 1+ months, respectively.

CONCLUSION: C psittaci–eradicating antibiotic therapy with doxycycline is followed by objective response in patients with ocular adnexal lymphoma, even after multiple relapses of the disease. A confirmatory, large, phase II trial is warranted to confirm whether this fast, cheap, and well-tolerated therapy could replace other more aggressive strategies as first-line treatment against ocular adnexal lymphomas.

Supported in part by a grant from the Italian Association for Cancer Research (R.D.).

Presented in part as an oral presentation at the Presidential Symposium of the 9th Annual Meeting of the European Hematology Association, Geneva, Switzerland, June 12, 2004; and published in abstract form as: Ferreri AJM, Guidoboni M, Ponzoni M, et al: The high prevalence of Chlamydia psittaci infection in ocular adnexal lymphomas (OAL) provides the rationale for the use of antibiotics as a potential therapeutic strategy in these patients. Hematol J 5:S111, 2004 (suppl 2, abstr 321).

A.J.M.F., M.P., and M.G. contributed equally to this work.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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