Hashimoto and coworkers presented long-term outcomes of 78 OAML patients Pepstatin A treated with radiotherapy. Local control rates were excellent as no patient had locally recurrent disease, and 10 patients relapsed at a distant site. HO-3867 Interestingly, 20 of those 78 patients received not only radiotherapy but combined treatment with immuno-/chemotherapy and none of these 20 patients had systemic recurrence, suggesting a potential benefit of systemic treatment in OAML. In addition it has been suggested that MALT lymphoma is a disseminated diseases in up to one third of patients at diagnosis and relapses may occur even after a prolonged period of time. Several recent prospective and retrospective series have dealt with antibiotic therapy of OAML. Especially data reported by Ferreri and coworkers have repeatedly demonstrated the efficacy of eradication therapy with doxycycline 200 mg daily resulting in high response rates up to 45�C65%. In addition, Govi et al presented relapsed/refractory OAML treated with clarithromycin showing equal response rates on a potential background of direct antitumor activity as supposed for macrolides. However, strong geographic variations of this bacteria have been reported in the past and eradication therapy was equally effective in CP negative patients in some series as also highlighted in a review recently published by our institution. In the present work nine patients were treated up-front with doxycycline or clarithromycin and two complete remissions were achieved though overall response rate was rather low when compared with other treatments. However, significant side effects of antibiotic therapy are extremely rare and the median follow up time in this group of 20 months is still relatively short. Six patients refused initial therapy; two were lost-to follow up due to a lack of compliance and the remaining four needed systemic treatment after a mTTP of 32 months. This long period, as well as the absence of severe complications/symptoms occurring in the period of non-treatment, suggest that a waitand-see policy might be a reasonable option in some patients if affection of the optic nerve can be ruled out upfront by imaging and broad ophthalmological tests.