Antiviral therapy in hepatitis C-infected patients prevents relapse of diffuse large B cell lymphoma

Abstract

IntroductionHepatitis C infection (HCV) is highly prevalent worldwide and has a well-known association with B-cell lymphoid malignancies. While several studies have demonstrated that antiviral therapy (AT) is effective to induce a complete hematological response in HCV-related low-grade B cell lymphoma, in HCV-related high-grade B cell non-Hodgkin lymphomas such as diffuse large B cell lymphoma (DLBCL) chemotherapy is the only possible choice. However, the role of AT to reduce relapse of DLBCL after an effective chemotherapy containing rituximab (CT-R) has not been analyzed in previous studies. Therefore we analyzed whether patients with a sustained virological response (SVR) to AT had over time a reduction of lymphoma relapse compared to no-SVR patients.Material and methodsThe study included 21 consecutive HCV-infected patients affected by DLBCL. The patients were treated with AT (direct-acting antivirals or pegylated interferon alfa plus ribavirin) concomitantly or after CT-R. Over time, we evaluated relapse of DLBCL in patients treated with CT-R according to response to AT.ResultsAn SVR was achieved in 16 of 21 patients. Five patients relapsed on AT with PegIFN/R (pegylated interferon plus ribavirin). Over time lymphoma relapse was more frequent in patients without a virological response compared with patients with an SVR (RR = 12.0, 95% CI: 1.66-86, p < 0.01 Fisher’s exact test).ConclusionsAT during or after CT-R is an important strategy to prevent relapse of DLBCL in HCV patients when the patients have achieved an SVR. Our results suggest that eradication of HCV infection may result in long-term prevention of B-cell non-Hodgkin’s lymphoma relapse.

Extranodal Diffuse Large B-Cell Lymphoma of Bone and Soft Tissue Presenting With Marked Lymphedema and Hypercalcemia

“…Furthermore, successful eradication of HCV may improve long-term outcomes in DLBCL. In a study by Pellicelli et al, a cohort of 21 patients with HCV and DLBCL received antiviral therapy during or shortly after achieving remission with chemotherapy [15]. Relapse was uncommon when HCV eradication was successful, but DLBCL relapse occurred in four out of five patients without sustained virologic response.…”