Journal article
Antibiotics and Imiquimod for Cutaneous T-Cell Lymphoma in Veterans: A Patient Population with Agent Orange Exposure
The oncologist (Dayton, Ohio), Vol.26(9), pp.727-e1488
09/2021
DOI: 10.1002/onco.13785
PMCID: PMC8417862
PMID: 33851477
Abstract
Staphylococcus aureus infection in cutaneous T-cell lymphoma (CTCL) is thought to contribute to disease progression; thus, adjunctive treatment with antibiotics warrants further investigation. This trial of antibiotic therapy followed by imiquimod in early stage CTCL was not completed because of difficulties with patient accrual.
Cutaneous T-cell lymphoma (CTCL), a form of non-Hodgkin lymphoma, is a heterogeneous group of malignancies of mature memory T lymphocytes. It has an annual age-adjusted incidence of 7.5 per million persons in the U.S. population [1]. The etiology of CTCL is unknown, but epidemiological studies have reported potential associations with environmental and occupational factors, including Agent Orange exposure in Vietnam Veterans [2]. Both topical and systemic therapies have been identified as effective in CTCL; the choice of treatment is dependent on disease stage, with the overall goal of improving symptoms given the chronic and recurrent nature of the disease. Several studies have suggested that CTCL is exacerbated by the presence of Staphylococcus aureus in the skin and can be ameliorated by treatment with antibiotics [3].
Our study was designed to assess the effects of antibiotics and imiquimod on early stage CTCL. Patients between the ages of 30-89 years with stage I and II CTCL were eligible for enrollment. They could not be receiving concurrent therapy, and the study design included a 14-day washout period after discontinuation of CTCL therapy. The washout period was followed by doxycycline 100 mg p.o. b.i.d. for 14 days and then two packets (250 mg per packet) of imiquimod 5% cream topically to the most clinically active lesions 3 days a week (Monday, Wednesday, and Friday) for 28 days. Skin lesions were measured using the modified Severity Weighted Assessment Tool (mSWAT).
Our study enrolled only two patients with early stage CTCL because of difficulty locating patients with active CTCL able to discontinue all therapy. The two enrolled patients completed all therapy. One patient had a complete response after imiquimod, whereas the other patient had stable disease.
Antibiotics and imiquimod have reported activity as single agents in CTCL; we did not enroll enough patients to assess value in the sequence of antibiotic therapy followed by imiquimod.
Details
- Title: Subtitle
- Antibiotics and Imiquimod for Cutaneous T-Cell Lymphoma in Veterans: A Patient Population with Agent Orange Exposure
- Creators
- Christina A Del Guzzo - University of PennsylvaniaArsenije Kojadinovic - James J. Peters VA Medical CenterRavi R Vinnakota - James J. Peters VA Medical CenterLarisa J Geskin - Columbia University Irving Medical CenterJessica C Newman - James J. Peters VA Medical CenterErik Langhoff - Department of Nephrology, Mt. Sinai School of Medicine, New York, New York, USAYeun-Hee A Park - Columbia University Irving Medical CenterSusan E Bates - Columbia University Irving Medical CenterAli N Dana - Columbia University Irving Medical Center
- Resource Type
- Journal article
- Publication Details
- The oncologist (Dayton, Ohio), Vol.26(9), pp.727-e1488
- DOI
- 10.1002/onco.13785
- PMID
- 33851477
- PMCID
- PMC8417862
- ISSN
- 1083-7159
- eISSN
- 1549-490X
- Language
- English
- Date published
- 09/2021
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984694747902771
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