Antiviral therapy is associated with a better survival in patients with hepatitis C virus and B‐cell non‐Hodgkin lymphomas, ANRS HC‐13 lympho‐C study

Abstract

on behalf of the ANRS HC-13 Lympho-C Study Group Hepatitis C virus (HCV) infection increases the risk of B-cell non-Hodgkin lymphomas (B-NHL). Antiviral treatment (AT) can induce hematological responses in patients with marginal zone lymphomas (MZL). The ANRS HC-13 Lympho-C study aimed at a better understanding of the impact of AT on HCV associated B-NHL. This multicentric study enrolled 116 HCV-positive patients with B-NHL between 2006 and 2012. Cytological and histological samples were collected for centralized review. At lymphoma diagnosis, median age was 61 years and gender ratio M/F was 1. Cytohistological distribution was marginal zone lymphoma (MZL) n 5 45 (39%), diffuse large B-cell lymphoma (DLBCL) n 5 45 (39%), and other types n 5 26 (22%). MZL patients had more frequent detection of rheumatoid factor (68% vs. 35%; P 5 0.001) and more frequently mixed cryoglobulinemia (74% vs. 44%; P 5 0.021) than patients with DLBCL. Among patients receiving AT, a sustained virologic response was achieved in 23 of 38 (61%) patients with MZL and in 9 of 17 (53%) with DLBCL (P 5 0.42). Three-year overall survival (OS) and progression-free survival were 78% 95%CI and 64% , respectively, without difference between cytohistological groups. Outcome analysis showed a favorable association between OS and AT in all patients (P 5 0.05) and in the subgroup of MZL patients only (P 5 0.04). Our data support that AT improves the outcomes of HCV-associated NHLs. The impact of new AT regimen with protease inhibitor needs to be investigated in this setting. [clinicalTrials.gov Identification number NCT01545544]Am.

Hepatitis C and Its Relation to B-Cell Lymphoma

“…Severe hepatotoxicity occurred in 14% of patients but was not associated with the use of RTX. 54 A recent prospective study including 45 patients with HCV infection and DLBCL, all treated with R-CHOP, found a 3-year OS of 73%, 55 which is similar to the results found in HCV-negative DLBCL treated with R-CHOP. Antiviral therapy following CT-induced NHL remission permits to achieve a prolonged disease-free survival (P = .038).…”

Hepatitis C virus-associated B-cell non-Hodgkin’s lymphomas: what do we know?

“…Interestingly, the presence of these mutations was associated with a shorter overall survival (OS) and with the presence in the diagnostic biopsy of a small cell component that suggests a possible histologic transformation of the DLBCL [Arcaini et al 2015]. It is already known that NOTCH is a pathway involved in the pathogenesis of SMZL: this finding seems to correlate with the observation that a high proportion of DLBCLs in HCV-positive individuals can arise from a preceding MZL [Besson et al 2006;Michot et al 2015].…”

“…Some distinctive characteristics can however be highlighted, which may be, at least in part, attributable to the presence of the HCV infection itself. First, patients who are HCV-positive more frequently present high transaminase levels, monoclonal gammopathies, autoimmune phenomena, rheumatoid factor and asymptomatic cryoglobulinemia [Musto, 2002;Michot et al 2015]. Second, at presentation, the involvement of the spleen or extranodal sites, which are also common target organs of HCV (i.e.…”

Regression of an HCV-associated disseminated marginal zone lymphoma under IFN-free antiviral treatment

“…3 Whether these effects are due to HCV clearance or to an antiproliferative effect of interferon remains unknown. We describe a patient with a complete hematologic response of an HCV-associated disseminated marginal zone lymphoma (MZL) to an interferon-free anti-HCV treatment.…”

“…4 Moreover, interferon-based antiviral treatment has been shown to improve the prognosis of HCV patients with B-cell lymphomas. 3 The underlying mechanism is still debated, with a potential antiviral and/or antiproliferative effect of interferon.…”