Abstract
There is mounting epidemiologic, histologic, experimental and therapeutic evidence that MALT (mucosa-associated lymphoid tissue) lymphomas may be related to chronic infections. While H. pylori infection-initiated MALT lymphomas of the stomach are now well documented, only recently has evidence for infectious sources of MALT lymphomas of the intestine (Campylobacter), skin (Borrelia), and the eye (Chlamydia) been reported. Chlamydia psittaci has been implicated in ocular MALT lymphoma in 2 reports (Ferreri et al, JNCI , 96(8):586–594, 2004 and Yeung et al, Cornea , 23:71–75, 2004). In these reports, only 2 of 4 evaluable patients treated with doxycycline were noted to have objective responses. We retrospectively reviewed data on 4 patients who have now undergone antibiotic therapy for subconjunctival MALT lymphomas, three of whom are evaluable for response to treatment. Complete evaluations for systemic disease (including CT scans of neck, chest, abdomen, pelvis, PET scans, and bone marrow examination) were all negative. Serologic tests for antibodies to Chlamydia psittaci were negative in all 4 individuals. Patients were 58, 74, 76 and 79 years of age with 2 males and 2 females. Treatment of one patient was with a PrevpacR (lansoprazole 30 mg capsule, amoxicillin 500 mg capsules, and clarithromycin 500 mg tablets BID) x 14 days, while three received doxycycline 100 mg daily for one month. Of the three patients evaluable to date for response, all demonstrated prompt and sustained responses (2 CR and 1 PR) with followup of 38 months, 12 months, and 7 months respectively. Definitive evidence for a particular infectious organism was not demonstrated, but the prompt and sustained response to antibiotics is consistent with an infectious origin. While further evaluation and followup is warranted in additional patients, we conclude that a trial of anti-microbial therapy should be considered for patients diagnosed with ocular MALT lymphoma.
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