Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Waehringer Guertel 18–20,Vienna, Austria.
Blood. 2013 Aug 22;122(8):1350-7. doi: 10.1182/blood-2013-02-486522. Epub 2013 Jun 14.
Although antibiotic therapy has been established as the standard of care in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, much less is known about the value of antibiotic therapy in nongastrointestinal (non-GI) MALT lymphomas. A computerized search (Medline) accompanied by a manual search to identify clinical reports on the topic of antibacterial therapy in patients with non-GI MALT lymphomas was performed. The majority of data were available for MALT lymphoma of the ocular adnexa (OAML) including a total of 131 patients in 4 retrospective studies, 3 prospective series (including 81 patients), and 1 case report. Treatment was exclusively targeting Chlamydophila psittaci (CP), using doxycycline in all but 2 studies. The median follow-up for these studies was 25 months, and both CP-positive as well as CP-negative patients responded. Complete remission was achieved in 23 patients (18%), 36 (27%) had a partial remission, 55 (42%) had stable disease, and 8 patients (6%) had progressive disease accounting for an overall response rate of 45%. In the largest study, a better response was suggested in CP-positive patients. By contrast, only scattered reports could be found for other non-GI localizations, allowing no conclusion about the benefit of antibiotic therapy and probably resulting in a publication bias toward positive cases. Based on these results, antibiotic therapy using doxycycline appears to be a reasonable first-line therapy for patients with OAML. Antibiotics, however, remain experimental for the time being in patients with other non-GI MALT lymphomas. Further preclinical studies as well as large-scale therapeutic trials are warranted to define the role of antibiotic therapy in such patients.
尽管抗生素治疗已被确立为胃黏膜相关淋巴组织（MALT）淋巴瘤患者的标准治疗方法，但对于非胃肠道（非-GI）MALT 淋巴瘤中抗生素治疗的价值知之甚少。进行了计算机检索（Medline）并辅以手动检索，以确定关于非-GI MALT 淋巴瘤患者抗菌治疗的临床报告。大多数数据可用于眼附属器（OAML）MALT 淋巴瘤，包括 4 项回顾性研究中的 131 例患者、3 项前瞻性系列研究（包括 81 例患者）和 1 例病例报告。所有研究均采用多西环素治疗，除了 2 项研究外，均针对衣原体（CP）。这些研究的中位随访时间为 25 个月，CP 阳性和 CP 阴性患者均有反应。23 例患者（18%）达到完全缓解，36 例（27%）部分缓解，55 例（42%）病情稳定，8 例（6%）疾病进展，总缓解率为 45%。在最大的研究中，CP 阳性患者的反应更好。相比之下，对于其他非-GI 定位，只能找到零星的报道，因此无法得出抗生素治疗有益的结论，并且可能存在对阳性病例的发表偏倚。基于这些结果，使用多西环素的抗生素治疗似乎是 OAML 患者的合理一线治疗方法。然而，抗生素治疗在其他非-GI MALT 淋巴瘤患者中仍处于实验阶段。需要进一步的临床前研究和大规模治疗试验来确定抗生素治疗在这些患者中的作用。
