Possible clinical effects of macrolides on the treatment of primary pulmonary mucosa-associated lymphoid tissue lymphoma

Abstract

pulmonary nodules in left S and S were observed in December 2009 (Fig. 1d), CAM was increased to 400 mg/ day in January 2010. The nodules remained unchanged, and AZM (750 mg/week) was added to CAM (400 mg/ day) in November 2010, which subsequently decreased the nodules 2 months later (Fig. 1e). These findings in the left lower lobe were unchanged in December 2014 (Fig. 1f). Case 2: A 58-year-old Japanese woman with multiple cystic lesions (Fig. 1g) was diagnosed with p-MALToma in 2010. CAM (400 mg/day) was started in November 2010, and the chest CT findings remained unchanged for 2 years (Fig. 1h, i). CAM was discontinued at the patient’s request in May 2012; however, a pulmonary nodule in the left upper lobe was observed in May 2014, but increased in size over time (Fig. 1j). A bronchoscopic examination revealed lymphocytic inflammatory change, and she restarted CAM (400 mg/day) therapy in October 2014. The nodular lesion started to decrease in December 2014 (Fig. 1k) and nearly disappeared by May 2015 (Fig. 1l). The comprehensive mechanism of action of macrolides on MALToma remains unclear. However, among macrolides, AZM is more concentrated in cells, which may help to induce the apoptosis of T-lymphocytes that may be included in the pathogenesis and progression of MALToma, and anti-inflammatory and immunomodulatory effects of macrolides may also indirectly suppress tumor progression of p-MALToma. The clinical course of Case 1 may show the potential combined effects of CAM and AZM therapy. In addition, the long-term follow-up of Case 2 demonstrates the clinical suppressive effect of CAM on p-MALToma. In addition to rituximab monotherapy or use of this drug in combination with other agents, we think that macrolides represent a potentially beneficial alternative treatment choice of p-MALT lymphoma; however, further studies are needed to elucidate the most effective strategy for the treatment of p-MALToma. To the Editor,