Primary
follicular lymphoma of the duodenum (FL-D) constitutes a rare subtype of extranodal
follicular lymphoma with a usually indolent course. To date, no distinct treatment recommendations have been defined for those patients. We report the case of a 58-year-old male patient presenting with endoscopically assessed, symptomatic FL-D who was treated with
clarithromycin monotherapy in analogy to recent data for
mucosa-associated lymphoid tissue lymphoma. Each treatment cycle consisted of
clarithromycin 500 mg twice daily for 3 weeks followed by a 2-week break. After four cycles of treatment, the patient showed a very good response with normal macroscopic findings confirmed by endosonographic examination and only focal
minimal residual disease of
lymphoma persisting in the histological assessment. The patient is currently asymptomatic and without treatment for 24+ months. As
clarithromycin combines antimicrobial and direct antiproliferative effects mediated through a variety of pleiotropic mechanisms, this appears to be an interesting treatment approach for indolent
lymphoma, particularly in those where a chronic infectious background cannot be completely ruled out, i.e., gastrointestinal manifestations. We suggest further investigation of this treatment approach.