Antiviral therapy improves overall survival in hepatitis C virus‐infected patients who develop diffuse large B‐cell lymphoma

Abstract

Chronic Hepatitis C virus (HCV) infection is associated with increased incidence of non-Hodgkin lymphoma. Several studies have demonstrated regression of indolent lymphoma with antiviral therapy (AVT) alone. However, the role of AVT in HCV-infected patients with diffuse large B-cell lymphoma (DLBCL) is unclear. We therefore analyzed AVT’s impact on oncologic outcomes of HCV-infected patients (cases) who developed DLBCL. Cases seen at our institution (June 2004-May 2014) were matched with uninfected counterparts (controls) and then divided according to prior AVT consisting of interferon-based regimens. We studied 304 patients (76 cases and 228 controls). More cases than controls had extranodal (79% v 72%; p=0.07) and upper gastrointestinal (GI; 42% v 24%; p=0.004) involvement. Cases never given AVT had DLBCL more refractory to first-line chemotherapy than that in the controls (33% v 17%; p=0.05) and exhibited a trend toward more progressive lymphoma at last examination compared to controls (50% v 32%; p=0.09) or cases given AVT (50% v 27%; p=0.06). Cases never given AVT had worse 5-year overall survival (OS) rates than did the controls (HR, 2.3 [95% CI, 1.01-5.3]; p=0.04). Furthermore, AVT improved 5-year OS rates among cases in both univariate (median [Interquartile range]: 39 [26-56] v 16 [6-41] months, p=0.02) and multivariate analyses (HR=0.21 [95% CI, 0.06-0.69]; p=0.01). This study highlights the negative impact of chronic HCV on survival of DLBCL patients and shows that treatment of HCV infection is associated with a better cancer response to chemotherapy and improves 5-year OS.

Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication

“…In our population, none of the patients presented with HBV and HIV coinfection and, as in other studies, the age‐adjusted incidence of lymphoid and related tissue cancers was higher when compared to the general French population (SMR, 2.03; 95% CI, 1.11‐3.41; P = 0.023), which also applied to patients without any cancer risk factors (SMR, 2.08; 95% CI, 1.14‐3.50; P = 0.019) and those without an SVR (SMR, 2.74; 95% CI, 1.18‐5.40; P = 0.021). In some studies, the clearance of HCV infection was associated with a reduction in hematological malignancies, a better response to chemotherapy, and an improvement in overall survival . Interestingly, the age‐adjusted incidence of lymphoid and related tissue cancers was higher when compared to the general French population, independently of the existence of risk factors and SVR achievement.…”

“…A sustained viral response (SVR) in HCV patients and maintained viral suppression (MVR) by nucleos(t)ide analogues in HBV patients have changed the clinical course of viral cirrhosis during recent decades. Several studies have suggested a lower incidence of liver‐related complications as well as the regression of NHL following viral control or eradication . The long‐term follow‐up of patients with a negative HBV viral load and SVR is now the next challenge as these patients are going to live for longer and will therefore be exposed to extrahepatic complications like EHC, as is observed in the general population.…”

Clinicopathologic characteristics and outcomes of transformed diffuse large B‐cell lymphoma in hepatitis C virus‐infected patients

“…The findings of our study confirm the high frequency and aggressive nature of CD5‐positive DLBCL cells in HCV‐infected patients. It may also explain, at least in part, the high relapse rate of CD5‐positive DLBCL seen in this study and the HCV‐driven resistance of DLBCL to chemotherapy we observed in our previous work …”

Concurrent Systemic Chemoimmunotherapy and Sofosbuvir-Based Antiviral Treatment in a Hepatitis C Virus-Infected Patient With Diffuse Large B-Cell Lymphoma

“…This was recently echoed in a meta-analysis conducted by Peveling-Oberhag et al [10], who found that achievement of SVR was associated with a higher rate of clinical response to lymphoma (73% response vs 53% response; 95% CI 39–67%; P < .05). The benefit of antiviral therapy in patients with HCV-associated DLBCL has also been associated with improved 5-year overall survival rates when compared with those who did not receive treatment for their HCV infection [11, 12]. …”