In a small, preliminary study investigating the effects of aggressive antibiotic therapy in patients with advanced, refractory cutaneous T-cell lymphomas (CTCLs), the broad-spectrum antibiotic carbapenem improved clinical symptoms. Results were published in Blood.

In patients with CTCL, infection with Staphylococcus aureus is a major contributor to morbidity and mortality. Additionally, enterotoxin production by S. aureus can act as a superantigen and potent activator of T cells in vitro, and it may play a role in the etiology and progression of CTCL. In previous research, antibiotics decreased tumor burden in patients with CTCL.

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In this study, 8 patients with advanced-stage, treatment-refractory CTCL and cutaneous lesions colonized by S. aureus received carbapenem. Six patients were male, and patients were between 57 years old and 74 years old.

All patients exhibited skin lesions with the presence of S. aureus at the beginning of the trial, but S. aureus could not be identified in 6 of 8 patients after 10 days. Absence of S. aureus persisted in 5 of the 6 patients at 1 month, and 3 of the 5 patients lacked S. aureus after 2 months. Six of the study participants had malignant T-cell clones in their biopsied skin, but antibiotic treatment reduced these levels after 60 days.

“[W]e provide the first evidence that aggressive antibiotic treatment inhibited proliferation of malignant T cells and disease activity in [patients with] advanced-stage CTCL,” the authors stated.

Immunohistochemistry, global mRNA expression, and cell-signaling pathway analysis in lesional skin suggested a general decrease in expression of CD25, STAT3 signaling, and cellular proliferation throughout the antibiotic treatment regimen. Gene expression profiles in several patients’ samples suggested healthy skin after 2 months of antibiotics.

The authors concluded that their research “provides novel evidence for a potential link between antibiotic treatment of S. aureus and disease activity as well as a rationale for aggressive antibiotic treatment as an important adjuvant therapy in patients with severe [CTCL] and lesional skin colonization with toxin-producing S. aureus.”

Reference

1.     Lindahl LM, Willerslev-Olsen A, Gjerdrum LM, et al. Antibiotics inhibit tumor and disease activity in cutaneous T-cell lymphoma [published online July 22, 2019]. Blood. doi:10.1182/blood.2018888107