Staphylococcus aureus infection in 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 due to 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 [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 S. 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 PO BID for 14 days and then two packets (250 mg per packet) of imiquimod 5% cream topically to the most clinically active lesions three 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 due to difficulty locating patients with active CTCL able to discontinue all therapy. Patients were managed as shown in Figure 1. The two enrolled patients completed all therapy. One patient had a complete response after imiquimod, while 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.
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