In the Journals

Antibiotics thwart disease activity in advanced cutaneous T-cell lymphoma

Antibiotics administered to treat Staphylococcus aureus appeared to inhibit disease activity among patients with advanced cutaneous T-cell lymphoma, according to results of a prospective study published in Blood.

The results suggest antibiotics could be an important adjuvant therapy for patients with advanced cutaneous T-cell lymphoma (CTCL), researchers noted.

“The immune defense often becomes impaired in [patients with advanced CTCL], who often die [of] infection rather than from the lymphoma per se,” Lise M. Lindahl, MD, clinical researcher in the department of dermatology at Aarhus University Hospital in Denmark, and colleagues wrote. “Interestingly, severe bacterial infections are almost exclusively seen after the diagnosis [of CTCL] has been established.”

CTCL is a rare and heterogeneous group of non-Hodgkin lymphomas that includes mycosis fungoides and Sézary syndrome.

One patient diagnosed with mycosis fungoides in 2003 at Aarhus University Hospital experienced gradual disease progression despite intensive anticancer therapy and presented with massive tumor burden in the skin in 2012. The patient developed severe sepsis, with Staphylococcus aureus as the suspected cause, and received IV carbapenem as antibiotic treatment. Anticancer therapy also was stopped.

Results showed almost complete clearance of tumor burden following antibiotic therapy.

In this study, Lindahl and colleagues sought to examine the impact of transient antibiotic treatment on tumor cells and disease activity among eight patients (age range, 57-74) with refractory CTCL. Patients received IV cephalosporin and metronidazole for 10 days, followed by oral amoxicillin and clavulanate for 14 days.

Researchers observed subjective improvement 10 days after the start of antibiotics, with Staphylococcus aureus no longer detectable.

After a follow-up of 2 months, all patients demonstrated marked clinical improvement, with a significant decrease in skin disease burden as measured by the modified severity weighted assessment tool (mSWAT).

Four patients reported a significant decrease in itching and pain severity, whereas three patients reported a modest decrease.

Two patients experienced clinical improvements after 8 months of antibiotic use. Six patients demonstrated a significant decrease in the fraction of malignant T cells observed after antibiotic treatment.

Aggressive antibiotic therapy also appeared associated with decreases in expression of IL-2 high-affinity receptors (CD25), STAT3 signaling and cell proliferation in lesional skin.

“The present study provides novel evidence for a potential link between antibiotic treatment of Staphylococcus aureus and disease activity as well as a rationale for aggressive antibiotic treatment as an important adjuvant therapy in [patients with CTCL] with severe disease and lesional skin colonization with toxin-producing Staphylococcus aureus,” Lindahl and colleagues wrote. – by John DeRosier

Disclosures : Lindahl reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

Antibiotics administered to treat Staphylococcus aureus appeared to inhibit disease activity among patients with advanced cutaneous T-cell lymphoma, according to results of a prospective study published in Blood.

The results suggest antibiotics could be an important adjuvant therapy for patients with advanced cutaneous T-cell lymphoma (CTCL), researchers noted.

“The immune defense often becomes impaired in [patients with advanced CTCL], who often die [of] infection rather than from the lymphoma per se,” Lise M. Lindahl, MD, clinical researcher in the department of dermatology at Aarhus University Hospital in Denmark, and colleagues wrote. “Interestingly, severe bacterial infections are almost exclusively seen after the diagnosis [of CTCL] has been established.”

CTCL is a rare and heterogeneous group of non-Hodgkin lymphomas that includes mycosis fungoides and Sézary syndrome.

One patient diagnosed with mycosis fungoides in 2003 at Aarhus University Hospital experienced gradual disease progression despite intensive anticancer therapy and presented with massive tumor burden in the skin in 2012. The patient developed severe sepsis, with Staphylococcus aureus as the suspected cause, and received IV carbapenem as antibiotic treatment. Anticancer therapy also was stopped.

Results showed almost complete clearance of tumor burden following antibiotic therapy.

In this study, Lindahl and colleagues sought to examine the impact of transient antibiotic treatment on tumor cells and disease activity among eight patients (age range, 57-74) with refractory CTCL. Patients received IV cephalosporin and metronidazole for 10 days, followed by oral amoxicillin and clavulanate for 14 days.

Researchers observed subjective improvement 10 days after the start of antibiotics, with Staphylococcus aureus no longer detectable.

After a follow-up of 2 months, all patients demonstrated marked clinical improvement, with a significant decrease in skin disease burden as measured by the modified severity weighted assessment tool (mSWAT).

Four patients reported a significant decrease in itching and pain severity, whereas three patients reported a modest decrease.

Two patients experienced clinical improvements after 8 months of antibiotic use. Six patients demonstrated a significant decrease in the fraction of malignant T cells observed after antibiotic treatment.

Aggressive antibiotic therapy also appeared associated with decreases in expression of IL-2 high-affinity receptors (CD25), STAT3 signaling and cell proliferation in lesional skin.

“The present study provides novel evidence for a potential link between antibiotic treatment of Staphylococcus aureus and disease activity as well as a rationale for aggressive antibiotic treatment as an important adjuvant therapy in [patients with CTCL] with severe disease and lesional skin colonization with toxin-producing Staphylococcus aureus,” Lindahl and colleagues wrote. – by John DeRosier

Disclosures : Lindahl reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.