Infectious disease associations in indolent lymphoma (follicular, FL and non-follicular, nFL): Developing a lymphoma prevention strategy

Abstract

6701 Background: The antigen-drive association of gastric MALT lymphoma with H. pylori is well recognized. Successful antibiotic therapy can result in lymphoma remission, and with it, lymphoma prevention. We have sought to prospectively identify possible associated infections (candidates for antigen-drive) in patients with non-bulky, advanced stage indolent lymphoma as the first step to such a lymphoma treatment/ prevention strategy. These patients are often given a recommendation of monitoring (“watch and wait”) and it is during this period that a window of opportunity may exist to identify and treat antigen-drive related infections. Methods: Patients with a new diagnosis of indolent lymphoma (FL and nFL), stages II (intra-abdominal), III and IV fulfilling GELF criteria for observation were eligible. Studies performed: Stool H. pylori, Hepatitis C and Borrelia serologies, Borrelia and Chlamydia fixed tissue PCR, peripheral blood mononuclear cell PCR for Chlamydia, and a hydrogen breath test for small bowel bacterial overgrowth. Results: To date 13 patients have been enrolled with IRB informed consent: 9 females, 4 males; median age, 51 years (34–70); 7 FL, 6 nFL; stage II (1 pt), III (3), and IV (9). All met GELF criteria for observation. Infections tested thus far include: H. pylori (3 positive, nFL); Hepatitis C (2+; 1FL, 1nFL); and small bowel bacterial overgrowth (3+; 1FL, 2nFL). Borrelia serologies were negative in all 13 pts. PCR for Borrelia and Chlamydia are pending. Thus, 7 of 13 patients have at least one positive study. These infections have been/are being treated and clinical outcomes of lymphoma will be assessed. Conclusions: Infections are common in advanced stage indolent lymphoma (54% to date in our series). The identification of antigen-drive associated infections may be a first step toward developing a lymphoma prevention strategy. No significant financial relationships to disclose.