Antibiotic treatment for bacteria-associated extranodal marginal zone lymphoma

Abstract

: Infectious agents have been frequently linked to lymphoproliferative disorders, and marginal zone lymphomas (MZL) certainly represent the most investigated entity. From the discovery of the role of Helicobacter pylori (Hp) in the pathogenesis of gastric mucosa-associated lymphoid tissue (MALT) lymphomas, other bacteria have been proposed as agents with lymphomagenesis capability. The associations between Chlamydia psittaci (Cp) infection and ocular adnexal MALT lymphoma, Borrelia strains and cutaneous MALT lymphoma, and Campylobacter jejuni (Cj) and immune-proliferative small intestine disease (IPSID) are those better studied. However, level of supportive evidence of these lymphoma-bacteria associations is variable and, often, their prevalence shows relevant variations among different geographical areas. Some of these micro-organisms have been proposed as targets of anti-lymphoma treatments based on the use of antibiotics, sometimes with encouraging results. In view of their indolent behavior, MZL represent an ideal model for a therapeutic approach less invasive and toxic as antibiotic therapy. The emerging role of macrolides, not only for the anti-infective properties, but also as direct antineoplastic agents has also been investigated. In vitro studies and preclinical models support the anticancer use of antibiotics, and a few clinical experiences have reported encouraging results with the use of macrolides, both as single agents and in combinations with other drugs, in some hematological malignancies, and in particular, multiple myeloma, Waldestrom macroglobulinemia and MZL. Herein, we review biological and clinical aspects as well as therapeutic implications of this bacteria-lymphoma association with the aim to provide diagnostic and therapeutic recommendations and discuss future perspectives in this interesting field of lab and clinical research.