Chlamydophila Psittaci eradication with doxycycline as first-line targeted therapy for ocular adnexae lymphoma: Final results of an international phase II trial

Andrés J M Ferreri, Silvia Govi, Elisa Pasini, Silvia Mappa, Francesco Bertoni, Francesco Zaja, Carlos Montalbán, Caterina Stelitano, Maria Elena Cabrera, Antonio Giordano Resti, Letterio Salvatore Politi, Claudio Doglioni, Franco Cavalli, Emanuele Zucca, Maurilio Ponzoni, Riccardo Dolcetti

Research output: Contribution to journalArticle

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Abstract

Purpose: The pathogenic association between Chlamydophila psittaci (Cp) and ocular adnexal marginal zone lymphoma (OAMZL) and the efficacy of doxycycline monotherapy have been investigated in retrospective series with variations in stage, management, and follow-up duration. To our knowledge, this is the first international phase II trial aimed at clarifying Cp prevalence and activity of first-line doxycycline in a homogeneous series of consecutive patients with newly diagnosed stage I OAMZL. Patients and Methods: Forty-seven patients were registered. Tumor tissue, conjunctival swabs, and peripheral blood from 44 patients were assessed for seven Chlamydiaceae infections by three polymerase chain reaction protocols. Thirty-four patients with measurable or parametrable disease were treated with doxycycline and assessed for chlamydial eradication and lymphoma response (primary end point). Results: Cp DNA was detected in biopsies of 39 patients (89%); no other Chlamydiaceae were detected. Twenty-nine patients had Cp DNA in baseline swabs and/or blood samples and were evaluable for chlamydial eradication, which was achieved in 14 patients (48%). Lymphoma regression was complete in six patients and partial in 16 (overall response rate, 65%; 95% CI, 49% to 81%); 11 had stable disease, and one had progressive disease. At a median follow-up of 37 months (range, 15 to 62 months), 20 patients remained relapse free (5-year progression-free survival [PFS] ± standard deviation, 55% ± 9%). Cp eradication was associated with improved response rate (86% v 47%; P = .02) and 5-year PFS (68% v 47%; P = .11). Conclusion: Upfront doxycycline is a rational and active treatment for patients with stage I Cp-positive OAMZL. Lymphoma regression is consequent to Cp eradication, which can easily be monitored on conjunctival and blood samples. Prospective trials aimed at identifying more effective administration schedules for doxycycline are warranted.

Original languageEnglish
Pages (from-to)2988-2994
Number of pages7
JournalJournal of Clinical Oncology
Volume30
Issue number24
DOIs
Publication statusPublished - Aug 20 2012

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Chlamydophila psittaci
Doxycycline
Lymphoma
Therapeutics
Chlamydiaceae Infections
Disease-Free Survival
Chlamydiaceae
DNA
Appointments and Schedules

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Chlamydophila Psittaci eradication with doxycycline as first-line targeted therapy for ocular adnexae lymphoma : Final results of an international phase II trial. / Ferreri, Andrés J M; Govi, Silvia; Pasini, Elisa; Mappa, Silvia; Bertoni, Francesco; Zaja, Francesco; Montalbán, Carlos; Stelitano, Caterina; Cabrera, Maria Elena; Resti, Antonio Giordano; Politi, Letterio Salvatore; Doglioni, Claudio; Cavalli, Franco; Zucca, Emanuele; Ponzoni, Maurilio; Dolcetti, Riccardo.

In: Journal of Clinical Oncology, Vol. 30, No. 24, 20.08.2012, p. 2988-2994.

Research output: Contribution to journalArticle

Ferreri, Andrés J M ; Govi, Silvia ; Pasini, Elisa ; Mappa, Silvia ; Bertoni, Francesco ; Zaja, Francesco ; Montalbán, Carlos ; Stelitano, Caterina ; Cabrera, Maria Elena ; Resti, Antonio Giordano ; Politi, Letterio Salvatore ; Doglioni, Claudio ; Cavalli, Franco ; Zucca, Emanuele ; Ponzoni, Maurilio ; Dolcetti, Riccardo. / Chlamydophila Psittaci eradication with doxycycline as first-line targeted therapy for ocular adnexae lymphoma : Final results of an international phase II trial. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 24. pp. 2988-2994.
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abstract = "Purpose: The pathogenic association between Chlamydophila psittaci (Cp) and ocular adnexal marginal zone lymphoma (OAMZL) and the efficacy of doxycycline monotherapy have been investigated in retrospective series with variations in stage, management, and follow-up duration. To our knowledge, this is the first international phase II trial aimed at clarifying Cp prevalence and activity of first-line doxycycline in a homogeneous series of consecutive patients with newly diagnosed stage I OAMZL. Patients and Methods: Forty-seven patients were registered. Tumor tissue, conjunctival swabs, and peripheral blood from 44 patients were assessed for seven Chlamydiaceae infections by three polymerase chain reaction protocols. Thirty-four patients with measurable or parametrable disease were treated with doxycycline and assessed for chlamydial eradication and lymphoma response (primary end point). Results: Cp DNA was detected in biopsies of 39 patients (89{\%}); no other Chlamydiaceae were detected. Twenty-nine patients had Cp DNA in baseline swabs and/or blood samples and were evaluable for chlamydial eradication, which was achieved in 14 patients (48{\%}). Lymphoma regression was complete in six patients and partial in 16 (overall response rate, 65{\%}; 95{\%} CI, 49{\%} to 81{\%}); 11 had stable disease, and one had progressive disease. At a median follow-up of 37 months (range, 15 to 62 months), 20 patients remained relapse free (5-year progression-free survival [PFS] ± standard deviation, 55{\%} ± 9{\%}). Cp eradication was associated with improved response rate (86{\%} v 47{\%}; P = .02) and 5-year PFS (68{\%} v 47{\%}; P = .11). Conclusion: Upfront doxycycline is a rational and active treatment for patients with stage I Cp-positive OAMZL. Lymphoma regression is consequent to Cp eradication, which can easily be monitored on conjunctival and blood samples. Prospective trials aimed at identifying more effective administration schedules for doxycycline are warranted.",
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T2 - Final results of an international phase II trial

AU - Ferreri, Andrés J M

AU - Govi, Silvia

AU - Pasini, Elisa

AU - Mappa, Silvia

AU - Bertoni, Francesco

AU - Zaja, Francesco

AU - Montalbán, Carlos

AU - Stelitano, Caterina

AU - Cabrera, Maria Elena

AU - Resti, Antonio Giordano

AU - Politi, Letterio Salvatore

AU - Doglioni, Claudio

AU - Cavalli, Franco

AU - Zucca, Emanuele

AU - Ponzoni, Maurilio

AU - Dolcetti, Riccardo

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N2 - Purpose: The pathogenic association between Chlamydophila psittaci (Cp) and ocular adnexal marginal zone lymphoma (OAMZL) and the efficacy of doxycycline monotherapy have been investigated in retrospective series with variations in stage, management, and follow-up duration. To our knowledge, this is the first international phase II trial aimed at clarifying Cp prevalence and activity of first-line doxycycline in a homogeneous series of consecutive patients with newly diagnosed stage I OAMZL. Patients and Methods: Forty-seven patients were registered. Tumor tissue, conjunctival swabs, and peripheral blood from 44 patients were assessed for seven Chlamydiaceae infections by three polymerase chain reaction protocols. Thirty-four patients with measurable or parametrable disease were treated with doxycycline and assessed for chlamydial eradication and lymphoma response (primary end point). Results: Cp DNA was detected in biopsies of 39 patients (89%); no other Chlamydiaceae were detected. Twenty-nine patients had Cp DNA in baseline swabs and/or blood samples and were evaluable for chlamydial eradication, which was achieved in 14 patients (48%). Lymphoma regression was complete in six patients and partial in 16 (overall response rate, 65%; 95% CI, 49% to 81%); 11 had stable disease, and one had progressive disease. At a median follow-up of 37 months (range, 15 to 62 months), 20 patients remained relapse free (5-year progression-free survival [PFS] ± standard deviation, 55% ± 9%). Cp eradication was associated with improved response rate (86% v 47%; P = .02) and 5-year PFS (68% v 47%; P = .11). Conclusion: Upfront doxycycline is a rational and active treatment for patients with stage I Cp-positive OAMZL. Lymphoma regression is consequent to Cp eradication, which can easily be monitored on conjunctival and blood samples. Prospective trials aimed at identifying more effective administration schedules for doxycycline are warranted.

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