Antiviral Therapy and Immunochemotherapy in Patients With Diffuse Large B‐cell Lymphoma (Dlbcl) With Hepatitis C (Hcv)

Abstract

Russian Federation; 4 Therapy, Clinical Hospital by V.M. Buyanova, Moscow, Russian Federation; 5 Radiology, Clinical Hospital by V.M. Buyanova, Moscow, Russian Federation Currently the association between hepatitis C virus and DLBCL widely accepted. The result of evidence from epidemiological and clinical studies carried out in the last decades. The majority of studies are ABSTRACT 439 related to antiviral therapy (AT) consisting of interferon (IFN) and ribavirin (RBV). New antiviral regimes without interferon allowed to obtain a high percentage of cure of patients from viral infection. There were limited data about efficacy of the new direct-acting antiviral agents (DAAs) in the treatment of patients DLBCL+HCV. The research objective is to analyze clinical, laboratory, morphological parameters and treatment results in patients with DLBCL+HCV who received DAA together with chemotherapy. Our study included 16 patients with DLBCL+HCV, who received DAA and immunohypotherapy (R-CHOP) from 2016 to 2019 at National Medical Research Center of Oncology named after N. N. Blokhin and Russian National Research Medical University named after N.I. Pirogov. The median age of patients was 48 years (32-75). Man/ woman ratio of was 10/6. All 16 patients had III-IV stages. Bsymptoms were present in 50% (8) of patients. Bulk disease occurred in 62%(10) of patients. Histological variants: 3 patients had GCB type DLCBCL, 13 patients -non-GCB type DLBCL. Spleen lesion was present in 37%(6) patients, bone marrow -in 31% (5) of patients, liver lesion -in 37%(6) of patients. Hb≤14,0g/dl were found in 37% (6) and platelets ≤100x10 9 /l in 25%(4) of patients. Before the treatment:increase level of LDH ≥450 IU/l was in 81%(13) of patients, ALT ≥40 (7) of patients, and albumin ≤35g/l in 37% (6) of patients. HCV RNA were detect in blood of all patients. In all patients the viral RNA was more then 1.6x10 6 IU/l. The 1st genotype of the virus was found in 63%(10) of patients. Before immunochemotherapy all patients received DAA therapy, according on the virus genotype. After 30 days of DAA therapy virology remission obtained in 94%(15) of patients. The level of ALT≤40 IU/l decreased at 81%(13) patients, AST ≤40 IU/l-62%(10) patients. DAA conducted during 4-6 months together with immunochemotherapy. The total response (ORR) of R-CHOP+DAA therapy was 50%. The 2-year survival without progression of the disease (PFS) was 25%. Median follow-up was 24 months. 56% of patients had a relapse of lymphoma. Median of OS was 20 months. Median DFS was 11 months. Conclusion: DAAs therapy makes it possible to complete the therapy program without complications for all patients with DLBCL + HCV. Safety, rapidity and efficacy of DAA in obtaining a virological response, as well as a good profile of tolerance DAA therapy can be used in combination with chemotherapy. Objective: To examine the efficacy of haploidentical stem-cell transplantation (haplo-SCT) for patients with refractory relapsed(R/R) aggressive non-Hodgkin lymphoma (NHL) by comparing with those who con...