How I treat hepatitis C virus infection in patients with hematologic malignancies

Abstract

Hepatitis C virus (HCV) infection is not uncommon in cancer patients. Over the past 5 years, treatment of chronic HCV infection in patients with hematologic malignancies has evolved rapidly as safe and effective direct-acting antivirals (DAAs) have become the standard-of-care treatment. Today, chronic HCV infection should not prevent a patient from receiving cancer therapy or participating in clinical trials of chemotherapy because most infected patients can achieve virologic cure. Elimination of HCV from infected cancer patients confers virologic, hepatic, and oncologic advantages. Similar to the optimal therapy for HCV-infected patients without cancer, the optimal therapy for HCV-infected patients with cancer is evolving rapidly. The choice of regimens with DAAs should be individualized after thorough assessment for potential hematologic toxic effects and drug-drug interactions. This study presents clinical scenarios of HCV-infected patients with hematologic malignancies, focusing on diagnosis, clinical and laboratory presentations, complications, and DAA therapy. An up-to-date treatment algorithm is presented.

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

“…Antiviral therapy with new direct‐acting agents is very effective, even in HCV‐infected cancer patients, with sustained virologic response rates higher than 90% . This therapy may eliminate HCV infection, downregulate the expansion of CD5‐positive B cells, and most importantly improve oncologic outcomes as already reported for selected patients with indolent NHL …”

Direct-acting antiviral agents in the therapy of hepatitis C virus-related mixed cryoglobulinaemia: a single-centre experience

“…Interestingly, new clinical scenarios are being opened following the treatment with DAAs of patients with chronic HCV infection who have hematologic malignancies [36]. In addition to preventing the development of some NHLs, the use of DAAs in fact may avoid HCV reactivation and hepatic flare after chemotherapy, may induce a better outcome after allogeneic bone marrow transplantation, and may reduce the risk of hepatic failure due to cytotoxic drugs, especially in patients with liver cirrhosis [36].…”

“…In addition to preventing the development of some NHLs, the use of DAAs in fact may avoid HCV reactivation and hepatic flare after chemotherapy, may induce a better outcome after allogeneic bone marrow transplantation, and may reduce the risk of hepatic failure due to cytotoxic drugs, especially in patients with liver cirrhosis [36]. …”

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

“…Although current recommendations defer antiviral therapy until after treatment of DLBCL [2], this patient was treated concurrently using a regimen for treatment-naive patients. The primary concern with concurrent antiviral therapy is the potential for drug-drug interactions or worsened drug toxicities, particularly with ribavirin and IFN.…”

“…For aggressive lymphomas, such as diffuse large B-cell lymphoma (DLBCL), treatment of HCV infection is typically deferred in treatment-naive patients until after completion of lymphoma therapy [1, 2]. We report a case of HCV-associated stage IV DLBCL successfully treated concurrently using chemoimmunotherapy and a sofosbuvir-based antiviral regimen.…”