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Feasibility of oral doxycycline as first-line therapy for conjunctival mucosa-associated lymphoid tissue lymphoma

Eye volume 38, pages 82–88 (2024)Cite this article

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A Correction to this article was published on 18 August 2023

This article has been updated

Abstract

Objectives

To investigate the long-term outcomes of oral doxycycline as first-line treatment in patients with conjunctival extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma).

Methods

In this case series, the medical records of 67 patients with conjunctival MALT lymphoma who received doxycycline as their primary treatment and were followed up for at least 5 years were retrospectively reviewed. Progression-free survival (PFS) was analysed at 3, 5, and 10 years after the initial doxycycline treatment. A Cox proportional hazards model was used to assess the independent risk factors for progression.

Results

After the initial treatment, 25 patients (37.3%) achieved a complete response, 8 patients (11.9%) achieved a partial response, 30 patients (44.8%) showed stable disease, and 4 patients (6.0%) showed disease progression. The median PFS in all patients was 168 months, and the 3-, 5- and 10-year PFS rates for all patients were 70%, 65%, and 62%, respectively. No further progression was observed 6 years after the initial doxycycline treatment. Younger age and TNM stage T1c were significant risk factors for the time to progression in the multivariate Cox regression analysis (p < 0.05). Additional doxycycline (>2 cycles) showed no benefit. There were no serious adverse events associated with doxycycline therapy, and most patients were successfully salvaged by second-line treatments, including radiotherapy and chemotherapy.

Conclusion

In this case series, oral doxycycline treatment yielded acceptable long-term PFS with minimal complications. Especially in patients with stage T1a or T1b conjunctival MALT lymphoma, first-line doxycycline treatment could be considered under close monitoring for at least 6 years.

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Fig. 1: Overall treatment sequence according to the response of first-line doxycycline therapy.
Fig. 2: Survival analyses and proposed treatment algorithm using doxycycline as first-line therapy.

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All data relevant to the study are included in the article or uploaded as supplementary information.

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Authors and Affiliations

  1. Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang-si, 14068, Republic of Korea

    Se Hyun Choi

  2. Department of Ophthalmology, Hallym University College of Medicine, Chuncheon, 24252, Republic of Korea

    Se Hyun Choi

  3. Department of Ophthalmology, Asan Medical Center, Seoul, 05505, Republic of Korea

    Min Kyu Yang

  4. Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea

    Tae Min Kim

  5. Department of Ophthalmology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea

    Hyuk Jin Choi

  6. Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 06236, Republic of Korea

    Hyuk Jin Choi

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Contributions

Concept and design: TMK and HJC. Acquisition, analysis, or interpretation of data: SHC, MKY, MK and HJC. Manuscript draft: SHC and HJC. Critical revision of the manuscript for important intellectual content: SHC, MKY, MK and HJC. Statistical analysis: SHC; Administrative, technical, or material support: MKY and TMK; Supervision: TMK and HJC; Guarantor: HJC.

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Correspondence to Hyuk Jin Choi.

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The original online version of this article was revised: The sentence “Older age and TNM stage T1c were significant risk factors for the time to progression in the multivariate Cox regression analysis (p<0.05)” in the abstract was corrected to read as follows: “Younger age and TNM stage T1c were significant risk factors for the time to progression in the multivariate Cox regression analysis (p<0.05)”.

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Choi, S.H., Yang, M.K., Kim, T.M. et al. Feasibility of oral doxycycline as first-line therapy for conjunctival mucosa-associated lymphoid tissue lymphoma. Eye 38, 82–88 (2024). https://doi.org/10.1038/s41433-023-02635-4

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  • DOI: https://doi.org/10.1038/s41433-023-02635-4

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